Clinical efficacy of free flap in repairing Gustilo IIIB and IIIC fractures of tibia and fibula combined with soft tissue defects

Abstract

Objective To investigate the clinical efficacy of free flap transplantation in repairing the Gustilo type IIIB and IIIC fractures of tibia and fibula combined with soft tissue defects. Methods A retrospective case series study was conducted on the clinical data of 46 patients who had Gustilo type IIIB and IIIC fractures of tibia and fibula with soft tissue defects admitted from June 2013 to January 2017. There were 34 males and 12 females, aged 1-67 years (mean, 39 years). The wound defect areas ranged from 6 cm×20 cm to 7 cm×38 cm. According to the Gustilo fracture classification, there were 31 cases of type IIIB and 15 cases of type IIIC. According to the AO fracture typing, there were five cases of type A, 23 type B, and 18 type C. All patients were repaired with free flap transplantation, among which 40 patients were treated with anterolateral thigh flap and six with latissimus dorsi flap. The areas of anterolateral thigh flap ranged from 6 cm×13 cm to 14 cm×32 cm, and those of the latissimus dorsi flap from 6 cm×22 cm to 7 cm×40 cm. Efficacy was evaluated by flap survival rate, complications, fracture healing time, lower limb function scoring system (LEFS), and skin flap function. Results All limbs were salvaged successfully. One case of total flap necrosis and eight cases of postoperative crisis occurred. After active exploration and treatment, three cases were seen distal local necrosis, and the total survival rate was 91%. Infection at the donor site was found in two cases. The complication incidence rate was 4%. All patients were followed up for 7-42 months, with an average of 19 months. The fracture healing time averaged 43.5 weeks, and the LEFS score averaged 54 points. According to the seven indexes of flap function, the results were excellent in 11 cases, good in 29 cases, fair in four cases, and poor in two cases, with an excellent and good rate of 87%. Conclusion Free flap transplantation can achieve satisfactory efficacy in treating Gustilo type IIIB and IIIC of tibia and fibula combined with soft tissue defects, with high limb salvage rate and good function recovery. Key words: Leg injuries; Fractures, open; Surgical flap