ROLE OF FASCIOCUTANEOUS FLAPS AS A METHOD OF SOFT TISSSUE COVERAGE IN TYPE 111 – B OPEN TIBIAL FRACTURES

Abstract

Abstract Object: To determine the role of fasciocutaneous flap as soft tissue coverage in type 111 – B open tibial Pahore M.K. 1 Assistant Professor Department of Orthopaedic Surgery and Traumatology, Liaquat medical university Hospital Jamshoro Laghari M.A. 2 Associate Professor Department of Orthopaedic Surgery and Traumatology Liaquat Medical University Hospital, Jamshoro Maher I.K. 3 Consultant Orthopaedic Surgeon, Department of Liaquat Medical University Hospital, Jamshoro Mugrai M.K. 4 Associate Professor, Department of Plastic Surgery, Liaquat Medical University, Jamshoro Pirwani M. 5 Associate Professor Department of Orthopaedic Surgery and Traumatology, Liaquat Medical University, Hospital, Jamshoro Memon S.A. 6 Consultant Orthopaedic Surgeon Liaquat Medical University, Jamshoro fractures. An experience by orthopaedic surgeons at LUMHS Jamshoro. Material and Methods: This prospective study was containing 41 patients with type 111 – B fracture of tibia. All cases were managed in department of ortho-paedic surgery and traumatology LUMHS Jamshoro from 2008 – 2012. Patients with diabetes mellitus and peripheral vascular disease were excluded from study. After resuscitation and antibiotic cover debridement done and back slab applied. On next day after routine investigations debridement was done and fracture was stabilized with external fixator. After multiple debride-ments as wound became clean and ready for flap, it is covered with appropriate fasciocuaneous flap. Dress-ing changed after 5 days and stitches removed after 2 weeks. Patients were assessed for their basic data, site of injury, type of fasciocutaneous flap ,their accep-tance and complications. Results: Average age was 31.8 years, According to site of injury 7 (16.66%) cases sustained in proximal tibia, 12 (28.57%) in middle tibia, 17 (40.47%) in dis-tal tibia, 4 (9.52%) in middle 2/3 rd of tibia and 2 (4.76%) in distal 2/3 rd of tiba. The pattern of execu-ted flaps were proximal based medial flaps in 4(9.52), proximal based lateral in 3 (7.14%), distal based med-ial in 8 (19%), distal based lateral in 17 (40.47%), cross leg in 2 (4.76%), sural flap in 2 (4.76%), distal lateral retrograde in 4 (9.52%), random pattern flaps in 2 (4.76%) and soleus muscle flaps in 2 (4.76%) cases. Out of 42 cases 33 (78.57%) were good, 6 (14.28%) fair and 3 (7.14%) poor. Complications noted were marginal necrosis in 6 (14.28%), partial or complete necrosis in 3 (7.14%), superficial infection in 3 (14.28%) and deep infection in 5 (11.9%) cases. Conclusion: It is concluded that fasciocutaneous flap is a simple, safe and cost effective procedure with good acceptance in type 111 – B open tibial fractures. Key Words: Type 111 – B open tibial fractures – soft tissue coverage – fasciocutaneous flaps.