Application of muscular flap and induced membrane technique in the emergency treatment for limb salvage for Gustilo type III B and III C open fracture of lower leg

Abstract

Objective To investigate the clinical effectivity of the muscular flap transposition and induced membrane technique in the emergency treatment for the limb salvage of Gustilo type III B/C open fracture of lower leg. Methods From July, 2015 to December, 2017, 10 cases of Gustilo type III B/C fracture of lower leg with bone defects were performed limb salvage surgery. Induced membrane technique was used to fill the bone defects in the emergency room. The gastrocnemius and/or soleus muscular flaps were transposed to cover the bone cement or exposed bone simultaneously in emergence treatment. After the wound healed completely, traditional bone grafting was used to repair the bone defects. There were 4 cases of Gustilo type III B and 6 cases of Gustilo type III C. The average length of bone defect was (5.25±1.70) cm ranging from 3.0 cm to 11.0 cm. The gastrocnemius medial head flaps were performed in 5 cases, the combined application with the gastrocnemius medial head flaps and the medial hemimuscular flaps of soleus were performed in 2 cases, and medial hemimuscular flaps of soleus were transposed in 3 cases. Results The wounds in 6 cases were healed at one stage, but 2 cases healed by dressing because the exudate after skin grafting. In 1 case, the cross-leg flap was used to cover the exposed bone cement due to the necrosis of soleus flap. The other 1 was performed the transposition of the lateral gastrocnemius flaps because the exposure of bone cement after the necrosis of the upper and lateral muscles in lower leg. In the second-stage, the bone defects were reconstructed by traditional bone grafting. The average healed time of bone was 7.2 months ranging from 5 months to 9 months. At the last followed-up time, all patients recovered their function of weight-bearing. The Paley's score of the adjacent joints: excellent in 8 cases and good in 2 cases. Conclusion The combination with induced membrane technique and local muscular flap transposition in emergency surgery is an effective method to limb salvage for the Gustilo type III B/C open fracture of lower leg. Key words: Gustilo type III, Gustilo type; Open fracture of lower leg; Induced membrane technique; Muscular flap; Emergency treatment