Treatment of compound tibial fracture with free osteomuscular latissimus dorsi scapula flap.

Abstract

Compound tibial fractures with extensive comminution and soft tissue defects are limb-threatening reconstructive challenges. The purpose of this study was to assess the long-term outcomes and the reliability of the latissimus dorsi scapula flap for this indication. The hospital records of 26 compound tibial fracture patients treated with the latissimus dorsi scapula flap were reviewed. An overall assessment was performed in several steps based on a preinformation and two function-related questionnaires together with radiographs, clinical overviews, and functional tests. In 85% of the cases, the fractures had resulted from high-energy trauma and had extensive zone of injury. The mean follow-up time was 6.2 years. Nine patients required reconstruction because of prolonged sequelae after infection, nonunion, or tissue deficiency. One flap loss occurred leading to amputation. Six patients required an additional operation to enhance bony union. Full weight-bearing was allowed in 3 months and the mean time to bony union was 10 months. Overall, 90% returned to their pretrauma occupation. Overall 11 patients were lost to follow-up. A total of 14 patients answered the questionnaires whereas 12 outpatients attended the clinical assessment. The main finding after evaluating the results of the functional tests and reviewing the questionnaires was the limitation in ankle movement while the donor site performed well. This study confirms that osteomuscular latissimus dorsi scapula flap reconstruction is a suitable alternative for compound and comminuted tibia fractures especially in the case of extensive soft tissue injury with bony loss or significant comminution and with high probability of amputation.