Use of single or double local muscle flap transfers for coverage of tibia bone exposure

Many studies emphasize the efficacy of combined orthopedic and plastic management for coverage of tibia bone exposure. However, many general hospitals do not have resident plastic surgery services to do free tissue transfers. This study, therefore, assesses the feasibility of applying single or double local muscle flap transfer to reconstruct soft-tissue defects and enhance orthopedic management. From July 2002 to December 2004, 34 patients with the same number of soft-tissue defects requiring 42 local muscle flaps were enrolled in the study. In this case series, no microvascular surgical intervention was performed and no plastic surgeons participated. Medical records were analyzed for clinical features, treatment strategies, and clinical outcomes. Comparisons were made between the single flap group and double flap group. All patients received regular follow-up for a minimum of 12 months. The survival rate of local muscle flap transfer was 95.2%. The double flap transfer group had significantly larger estimated defect areas than the single flap transfer group (P < 0.001). No statistical differences existed in healing time (P = 0.10) and complication rates (P = 0.58) between the groups. The authors conclude that local muscle flap transfer combined with orthopedic management, which is a far less complicated method than microvascular free tissue transfer, is suitable for the clinical practice when performed by orthopedic surgeons at regional hospitals that do not have plastic surgery support. When necessary, local transplantation of multiple muscle flaps is a safe, reliable, and effective treatment method.