Combined pedicled flaps for grade IIIB tibial fractures in children: A report of two patients

Severe open tibial fractures in children are associated with notable morbid ity and require early aggressive management to ensure a successful outcome. Free flaps are currently the gold standard in distal extremity reconstruct ion in which large soft-tissue defects exist, as is often the case with gra de IIIB fractures. In severe lower limb trauma, however, free flaps are ass ociated with a relatively high risk of failure, particularly when definitiv e soft-tissue coverage is delayed. Alternative methods of soft-tissue recon struction may, therefore, occasionally require consideration. The authors d escribe the combined use of three pedicled flaps to attain soft-tissue cove rage in 2 children with grade IIIB tibial fractures. These three flaps are individually in common use far tower limb soft-tissue coverage, are simple to raise, and in combination can cover extensive soft-tissue defects of the lower extremity. The major vascular axes of the limb are not sacrificed; h owever, the aesthetic result is modest.