Flap Impaling: A Simple and Effective Technique in Soft Tissue Reconstruction of Complex Extremity Wounds

Area of Science:

• Orthopedic Surgery
• Plastic and Reconstructive Surgery

Background:

• Composite defects involve compound comminuted fractures and significant soft tissue loss.
• Schanz pins are crucial for stabilizing fractures but complicate flap inset for reconstruction.
• Existing methods for flap inset can be complex and require extensive planning.

Purpose of the Study:

• To present a simple technique for flap inset over Schanz pins in composite defects.
• To evaluate the efficacy and safety of impaling flaps on Schanz pins for soft tissue reconstruction.
• To demonstrate a method that avoids disturbing skeletal fixation during flap reconstruction.

Main Methods:

• A technique of impaling fasciocutaneous and muscle flaps over Schanz pins was employed.
• Stab incisions were made to create passages for pins, preserving flap vascularity.
• The procedure was adapted for both free and pedicled flaps, including modifications for threading.

Main Results:

• The study included 16 flaps (15 lower limb, 1 upper limb) with 13 pedicled and 3 free flaps.
• All 16 flaps survived without loss, with four cases of suture line dehiscence managed conservatively.
• The impaling technique facilitated flap inset without compromising skeletal fixation.

Conclusions:

• Impaling flaps on Schanz pins offers a straightforward and effective method for soft tissue reconstruction in compound defects.
• This technique simplifies the surgical process, particularly in complex trauma scenarios.
• Thorough understanding of flap vascular anatomy is essential for successful pedicle preservation and flap survival.