MUSCULAR FLAPS FOR OPEN FRACTURES MANAGEMENT - A SERIES OF 42 CASES

Purpose of the study Since 1988, skin defect associated with upper (6 cases) or lower (34 cases) limb fractures were treated in our Orthopae dic Department with regional or free muscular flaps. The aim of this s tudy was to demonstrate that muscular flaps represent a treatment of c hoice for infection prevention and consolidation. Material and methods 42 patients have been treated: 29 Cauchoix III or IV, 12 secondary ex posed fractures, 1 amputation. A total of 42 flaps, including 28 regio nal flaps and 14 microvascular free-tissue tranfers were performed. A first stage included thorough debridement, fixation with external fixa tor in 85 per cent, and revascularization (4 cases). A second look was necessary in all but 3 cases: flap coverage was performed at this sta ge. A bone graft was proposed in 17 cases after a mean time of 3 month s and 20 days. Results Bony healing was found in 37 cases (86.5 per ce nt) with a mean delay of 7 months 20 days. 5 patients required another method of treatment because of flap necrosis or non-union, with an av erage time to bony healing of 13 months. 42 tissue transfers were perf ormed with an overall success rate of 95.3 per cent (2 necrosis of lat issimus dorsi flaps). 3 partial necrosis involved 2 regional and 1 fre e flap. One of them needed another treatment. No infection was encount ered in 40 cases (95 per cent) even if most of the patients were treat ed after initial treatment elsewhere. Discussion Experience with regio nal muscle transfer has advocated the gastrocnemius and proximal pedic le medial soleus as reliable and excellent choice for reconstruction o f the proximal and middle third of the leg. Latissimus dorsi transfer, which can be used totally, partially, or as a << vascular graft flap >> represent the treatment choice for extensive upper or lower limb ex posed fracture especially for distal lower limb fracture (exposure of the tibia). Muscle flap coverage in the acute period (within 48 or 72 hours) remains for us the best treatment.