FREE-FLAP RECONSTRUCTIONS OF TIBIAL FRACTURES COMPLICATED AFTER INTERNAL-FIXATION

The cases of 15 patients are presented where microvascular soft-tissue reconstructions became necessary after infernal fixation of tibial fr actures. Primarily, seven of the fractures were closed. Eleven fractur es had originally been treated by open reduction and internal fixation using plates and screws, and four by intramedullary nailing. All of t he patients suffered from postoperative complications leading to expos ure of the bone or fixation material. The internal fixation material w as removed and radical revision of dead and infected tissue was carrie d out in all cases. Soft tissue reconstruction was performed using a f ree microvascular muscle nap (11 latissimus dorsi, three rectus abdomi nis, and one gracilis). In eight cases the nonunion of the fracture in dicated external fixation. The microvascular reconstruction was succes sful in all 15 patients. In one case the recurrence of deep infection finally indicated a below-knee amputation. In another case, chronic in fection with fistulation recurred postoperatively. After a mean follow -up of 26 months the soft tissue coverage was good in ah the remaining 13 cases. All the fractures united. Microvascular free muscle flap re construction of the leg is regarded as a reliable method for salvaging legs with large soft-tissue defects or defects in the distal leg. If after internal fixation of the tibial fracture the osteosynthesis mate rial or fracture is exposed, reconstruction of the soft-tissue can suc cessfully be performed by free flap transfer. By radical revision, ext ernal fixation, bone grafting, and a free flap the healing of the frac ture can be achieved.