Is flap cover of exposed metalwork worthwhile? A review of 28 cases

The long term results of flap cover in 28 cases of exposed metalwork are presented. The patients fall into two groups; those with exposure of plates after internal fixation of fractures (14), and those with exposed knee or elbow prosthetic joints (14). The average duration of metal exposure at the time of referral was 6.4 weeks. In the majority of cases, cover was achieved by local muscle or fasciocutaneous flaps. The average duration of follow-up was 20 months. Metalwork was covered and preserved in 16 cases (57%). The remainder had persistent discharging sinuses or overt sepsis despite survival of the overlying flap. The results of this series are discussed in relation to the pre-operative microflora and the duration of metal exposure.