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Combined medial gastrocnemius and hemisoleus flap: a reproducible alternative for open tibial fractures complicated with large or double soft tissue defects

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

Abstract

Background

Utilization of combined local muscle flaps for Gustilo type IIIB open tibial fractures has not been clearly delineated. We describe a combination of medial gastrocnemius and hemisoleus flaps for managing open tibial fractures accompanying large or double soft tissue defects.

Methods

Twelve patients with Gustilo IIIB open fractures of the tibial shaft with large (9) or double (3) defects were operated on by fracture stabilization and combined medial gastrocnemius and hemisoleus flap coverage. Data were collected on types of implants, types of flaps, union time, postoperative complications, and Puno functional scores.

Results

Regarding implants for fixation, an intramedullary nail was used in three patients, plate and screws in five, combined plate and intramedullary nail in one, and definitive external fixation was used in three. Regarding soft tissue coverage, combined medial gastrocnemius and hemisoleus flaps were used in ten patients, combined hemigastrocnemius and hemisoleus in one, and combined medial gastrocnemius and reversed hemisoleus in one. All flaps survived, and all fractures were united with a mean union time of 19.7 weeks (range 16–24). Tip necrosis of the hemisoleus flap occurred in two patients. Regarding Puno functional score, one was determined to be excellent, nine was good and two was fair.

Conclusion

Combined medial gastrocnemius and hemisoleus flaps are reliable and effective for open tibial fractures complicated with large or double soft tissue defects.

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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, Kriangkamol Benjawongsathien, Chawanan Patamamongkonchai, Arthit Gromprasit & Witoon Thremthakanpon

Authors
  1. Surasak Jitprapaikulsarn
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  2. Kriangkamol Benjawongsathien
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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 and KB 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. CP, AG, and TW were involved in revising the manuscript for content and analysis and interpretation of data.

Corresponding author

Correspondence to Kriangkamol Benjawongsathien.

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Conflicts of interest

S. Jitprapaikulsarn, K Benjawongsathien, C. Patamamongkonchai, A. Gromprasit, and W. Thremthakanpon declare that they have no conflict of interest.

Ethical approval

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., Benjawongsathien, K., Patamamongkonchai, C. et al. Combined medial gastrocnemius and hemisoleus flap: a reproducible alternative for open tibial fractures complicated with large or double soft tissue defects. Eur J Orthop Surg Traumatol 31, 413–420 (2021). https://doi.org/10.1007/s00590-020-02772-6

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  • DOI: https://doi.org/10.1007/s00590-020-02772-6

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