Late functional outcome in patients with tibia fractures covered with free muscle flaps

The functional outcome and work capacity of patients treated with a free muscle flap to cover open grade III tibial fractures was assessed. The conditions of patients, eight with grade IIIB and six with grade IIIC isolated open tibia fractures, treated with a free muscle flap transfer less than 3 months after their injury, were retrospectively reviewed. Flap survival was 86%. Twelve of the 14 were contacted, with follow-up time averaging 7 years. Four of the 14 eventually had below-knee amputations and one of the 10 patients with a successful limb salvage died of unrelated causes. All nine surviving patients with salvaged limbs had healed fractures in an average of 15 months (range, 8-23). Six were initially infected, but drainage had stopped an average of 13.5 months after flap coverage. No wounds were draining at last follow-up observation. Those tibias that were initially infected have been drainage free for an average of 78 months. The average total hospital cost of reconstruction was $48,996.40. The functional outcome in 12 patients was assessed. Eight of the nine patients whose limbs were salvaged returned to work, six to jobs with demands similar to their preinjury occupation. Three of the four patients with limb amputations were also able to return to jobs similar to their preinjury occupation. Patients must be made aware of the expected course of reconstruction and anticipated final outcome. Despite rarely achieving normal function, returning to work is a reasonable goal.