Ring-and-flap: a novel and accessible alternative to fix-and-flap in Gustilo IIIB-C open tibia fractures (an...

The fix-and-flap regime is resource intense and may not be readily available. As an alternative, the ring fixator serves as a versatile option for limb salvage, however it poses challenges to soft tissue reconstruction due to the limited working space around the rings and pins. We describe an institutional experience with a novel ring-and-flap regime utilising an open ring technique-which optimises the ring fixator construct for the flexibility of interval soft-tissue reconstruction.

A retrospective review of patients treated with a novel ring-and-flap regime over 2017-2024 was conducted. Demographic data, comorbidities, intraoperative details, and postoperative outcomes were collected.

6 patients were included. Soft tissue reconstruction took place at a median of 12 days (minimum 2, maximum 154) after ring fixation. The median duration on the ring fixator was 144 days (minimum 74, maximum 270). Most patients (4/6) developed osteomyelitis but all achieved union and regained ambulatory function. 2/6 required flap revision due to vascular thrombosis. The ring fixator served as definitive fixation in 2 patients; whilst the remainder opted for internalisation.

The novel ring-and-flap regime may provide a practical and safe pathway for limb salvage in resource limited settings, bridging the gap until specialised ortho-plastics care is available.