[Coverage of Large Tibial Exposures with a Composite Anterior Leg Compartment Flap in Burn Patients]

Deep burns of the anterior leg often result in exposure of the anterior tibial crest. Several therapeutic strategies are used to cover this loss of substance: corticotomy, artificial dermis, local or free flaps. Each has its limitations. A simple, reliable and reproducible technique would be ideal. We have developed a technique involving translation of the muscles of the anterior compartment of the leg that could meet these expectations. We present a series of 8 of these flaps performed on 6 patients admitted to the CTB of the University Hospital of Bordeaux in order to evaluate their use and feasibility. Anatomical work was first performed to analyze vascularization. The surgical technique consisted of a corticotomy followed by release of the medial insertions against the tibia and the lateral adhesions against the fascia to transfer all the muscles of the anterior compartment to cover the tibia. Complete, immediate and long-lasting coverage was observed on all flaps, with healing achieved in 21 days. No functional changes or discomfort were noticed, and dorsiflexion was preserved. Translation of the anterior compartment of the leg allows coverage of extended tibial exposure to the distal third. This technique seems to be a good alternative to the other common strategies.