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Concurrent internal fixation and soft tissue reconstruction by distally based sural flap: a practicable scheme for complex distal tibial fractures

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

It is difficult to establish both fracture union and wound healing of open fractures complicated with soft tissue defects of the distal tibia. We describe the simultaneous use of internal fixation and soft tissue coverage by a distally based sural flap (DBSF) for these complex injuries.

Methods

Seventeen patients with Gustilo IIIB open fractures of the distal tibia were operated on by internal fixation and DBSF coverage. Data were collected on the size of the defect, time to fixation and soft tissue coverage or ‘fix & flap’, types of implant, time to union, postoperative complications and objective clinical measurement.

Results

The average size of the soft tissue defect after debridement was 6.4 × 8.4 cm2 (range 4.0–9.0 × 6.0–12.0). The mean time to fix & flap was 8.1 days (range 7–10). A medial precontoured plate was used in 8 patients and an anterolateral precontoured plate in 9. All fractures were united in a mean duration of 22.6 weeks (range 20–28). One patient had partial flap necrosis. Using the Puno functional score, 2 patients had excellent functional outcomes and 15 patients had good functional outcomes.

Conclusion

Concurrent Internal fixation and soft tissue reconstruction by DBSF is effective and reproducible for Gustilo type III open fractures of the distal tibia even in cases of more than 50 cm2 soft tissue defects.

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Acknowledgement

The authors thank Prof. Theerachai Apivatthakakul, Faculty of Orthopedics, Chiangmai University, Thailand for manuscript edition and preparation.

Funding

There was no source of funding for this research.

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Authors and Affiliations

  1. Department of Orthopedics, Buddhachinaraj Hospital, 90 Srithamtraipidok Road, Phitsanulok, 65000, Thailand

    Surasak Jitprapaikulsarn, Kritsada Sukha, Chawanan Patamamongkonchai, Arthit Gromprasit & Witoon Thremthakanpon

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  1. Surasak Jitprapaikulsarn
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  2. Kritsada Sukha
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  3. Chawanan Patamamongkonchai
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  4. Arthit Gromprasit
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  5. Witoon Thremthakanpon
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Contributions

SJ were involved in drafting and revising the manuscript for content, including medical writing for content, study concept and design, analysis and interpretation of data, as well as acquisition of the data. KS, CP, AG and WT were involved in revising the manuscript for content and analysis and interpretation of data.

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Correspondence to Surasak Jitprapaikulsarn.

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This study has been approved by the ethical committees of Buddhachinaraj Hospital in accordance with the Declaration of Helsinki.

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Jitprapaikulsarn, S., Sukha, K., Patamamongkonchai, C. et al. Concurrent internal fixation and soft tissue reconstruction by distally based sural flap: a practicable scheme for complex distal tibial fractures. Eur J Orthop Surg Traumatol 31, 711–718 (2021). https://doi.org/10.1007/s00590-020-02827-8

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  • DOI: https://doi.org/10.1007/s00590-020-02827-8

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