Reconstruction of Tibia Fracture With Soft Tissue Defect

Area of Science:

• Orthopedic Surgery
• Plastic Surgery
• Reconstructive Surgery

Background:

• Lower leg soft tissue defects with tibia fractures present complex reconstruction challenges.
• Free flaps and pedicled flaps are established methods for addressing these defects.
• Aesthetic outcomes and infection control are critical considerations post-reconstruction.

Purpose of the Study:

• To compare the efficacy of free flaps versus pedicled flaps for treating lower leg soft tissue defects with tibia fractures.
• To evaluate the impact of a one-stage secondary debulking procedure on aesthetic outcomes.
• To assess infection control rates following flap reconstruction.

Main Methods:

• A retrospective review of 83 patients undergoing lower leg reconstruction for tibia fractures from December 2000 to March 2017.
• Reconstruction utilized 71 free flaps and 12 pedicled flaps.
• A one-stage secondary debulking procedure was performed on 39 patients; outcomes were assessed over a 16-month follow-up using a 5-point Likert scale for aesthetics and infection control.

Main Results:

• All flaps (71 free, 12 pedicled) demonstrated a 100% survival rate with no osteomyelitis recurrence.
• The one-stage secondary debulking procedure resulted in statistically significant improvements in contour, color, and texture compared to non-debulked flaps.
• Various flap types were employed, including myocutaneous free flaps, fasciocutaneous free flaps, fibula free flaps, distally based sural artery flaps, and medial gastrocnemius flaps.

Conclusions:

• Free and pedicled flaps provide reliable solutions for lower leg defects with tibia fractures, achieving excellent infection control.
• The one-stage secondary debulking procedure is highly effective in delivering superior long-term aesthetic results for reconstructed tibia areas.
• Both flap types and the adjunctive debulking procedure contribute to successful functional and aesthetic restoration.