Transverse Incision for the Management of Infected Non-Unions of Tibia

Mussa Wardak,Emal Wardak,Ajmal Wardak

doi:10.4236/ss.2012.35050

Abstract

We are describing a transverse incision that we have found very useful in performing surgical procedures where the fractured site needs freshening, excision of the necrotic bones or shortening. Operative procedures using this technique have been extensively used by us since 1980 and we have registered 1187 cases with average follow up of 10 years. The incision is transverse and can be performed in any part of leg and extends from 1 cm lateral to anterior border of the tibia and runs medially till 1 cm medial to medial border of tibia. The incision allows adequate visualization of the interested area, less of periosteal stripping, ease of closure, no post operative wound dehiscence and cosmetically very much acceptable.

Highlights

Longitudinal incision in extremities are the standard incisions when we perform our daily surgical procedures, whether for fracture fixation, tumor excision, debridement etc., this is because longitudinal incisions have the advantage of being more anatomical, we don’t cross many zones in one section so we preserve the blood supply distally as well as sensations
We are describing a transverse incision that we have found very useful in performing surgical procedures where the fractured site needs freshening, excision of the necrotic bones or shortening
If we look at the anatomy of leg the antero-medial surface of the leg is covered only by skin and no significant neurovascular structure cross this area

Summary

Introduction

Longitudinal incision in extremities are the standard incisions when we perform our daily surgical procedures, whether for fracture fixation, tumor excision, debridement etc., this is because longitudinal incisions have the advantage of being more anatomical, we don’t cross many zones in one section so we preserve the blood supply distally as well as sensations. In our practice open compound fractures of tibia which are mainly due to warfare injuries have got infection and non union rate of as high as 40-50% [1], and while performing debridement, sequestrectomies and bone excisions using the longitudinal incision we found that we compromise the vascularity of the area by dissecting the periosteoum much more than required, and in areas we excise the necrotic fragments and create shortening, closure of the longitudinal incision is difficult and higher incision breakdowns [2]. We searched the literature and found no literature describing such an incision except few just mentioning about it [2,3,4]

Materials and Method

Operative Technique

Results and Discussion