Comparative Study of Muscle and Fascio-cutaneous Flaps for Coverage of Exposed Tibia

Abstract

Background- Trauma is a leading cause of tibial fractures. In salvageable lower limb trauma, morbiditycan be greatly reduced with early soft tissue coverage of exposed tibia. Muscle flaps have traditionallybeen preferred over fascio-cutaneous flaps for coverage. With better description of the vascular supplyof the lower limb, however, there is now a shift towards fascio-cutaneous flaps: pedicled or free softtissue transfer.Methods- 216 patients who underwent flap coverage for exposed tibia in our institute between January2015 and December 2020 were evaluated in this retrospective, comparative study. Parameters studiedwere surgical complications, such as partial or complete flap necrosis, minor wound complications,venous congestion, donor-site complications; development of wound infection and osteomyelitis;duration of hospital stay; functional outcome and final aesthetic outcomeConclusion- Fascio-cutaneous flaps were found superior to muscle flaps for coverage of exposed tibiain many respects especially for middle and lower third defects. For upper third of tibia, gastrocnemiusmuscle and musculocutaneous flaps provide adequate coverage. But in case of middle and lower thirds,adequate coverage can be provided by perforator-based, propeller or distal sural flaps. If adequatedonor vessels are available, micro-vascular free soft tissue transfer, should be the preferred choice forlarge defects.