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Pearls and tips in coverage of the tibia after a high energy trauma

Coverage of soft-tissue defects in the lower limbs, especially open tibial fractures, is currently a frequently done procedure because of the high incidence of high-energy trauma, which affects this location. The skilled orthopedic surgeon should be able to carry out an integral treatment of these l...

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Autores principales: Rios-Luna, Antonio, Fahandezh-Saddi, Homid, Villanueva-Martínez, Manuel, López, Antonio García
Formato: Texto
Lenguaje:English
Publicado: Medknow Publications 2008
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740344/
https://www.ncbi.nlm.nih.gov/pubmed/19753225
http://dx.doi.org/10.4103/0019-5413.43376
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author Rios-Luna, Antonio
Fahandezh-Saddi, Homid
Villanueva-Martínez, Manuel
López, Antonio García
author_facet Rios-Luna, Antonio
Fahandezh-Saddi, Homid
Villanueva-Martínez, Manuel
López, Antonio García
author_sort Rios-Luna, Antonio
collection PubMed
description Coverage of soft-tissue defects in the lower limbs, especially open tibial fractures, is currently a frequently done procedure because of the high incidence of high-energy trauma, which affects this location. The skilled orthopedic surgeon should be able to carry out an integral treatment of these lesions, which include not only the open reduction and internal fixation of the fracture fragments but also the management of complications such as local wound problems that may arise. There is a wide variety of muscular or pedicled flaps available for reconstruction of lower limb soft-tissue defects. These techniques are not commonly used by orthopedic surgeons because of the lack of familiarity with them and the potential for flap failure and problems derived from morbidity of the donor site. We present a coverage management update for orthopedic surgeons for complications after an open tibial fracture. We choose and describe the most adequate flap depending on the region injured and the reliable surgical procedure. For proximal third of the tibia, we use gastrocnemius muscle flap. Middle third of the tibia could be covered by soleus muscle flap. Distal third of the tibia could be reconstructed by sural flaps, lateral supramalleolar skin flap, and posterior tibial perforator flap. Free flaps can be used in all regions. We describe the advantages and disadvantages, pearls, and tips of every flap. The coverage of the tibia after a major injury constitutes a reliable and versatile technique that should form part of the therapeutic arsenal of all the orthopedic surgeons, facilitating the integral treatment of complex lower limb injuries with exposed defects.
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spelling pubmed-27403442009-09-14 Pearls and tips in coverage of the tibia after a high energy trauma Rios-Luna, Antonio Fahandezh-Saddi, Homid Villanueva-Martínez, Manuel López, Antonio García Indian J Orthop Review Article Coverage of soft-tissue defects in the lower limbs, especially open tibial fractures, is currently a frequently done procedure because of the high incidence of high-energy trauma, which affects this location. The skilled orthopedic surgeon should be able to carry out an integral treatment of these lesions, which include not only the open reduction and internal fixation of the fracture fragments but also the management of complications such as local wound problems that may arise. There is a wide variety of muscular or pedicled flaps available for reconstruction of lower limb soft-tissue defects. These techniques are not commonly used by orthopedic surgeons because of the lack of familiarity with them and the potential for flap failure and problems derived from morbidity of the donor site. We present a coverage management update for orthopedic surgeons for complications after an open tibial fracture. We choose and describe the most adequate flap depending on the region injured and the reliable surgical procedure. For proximal third of the tibia, we use gastrocnemius muscle flap. Middle third of the tibia could be covered by soleus muscle flap. Distal third of the tibia could be reconstructed by sural flaps, lateral supramalleolar skin flap, and posterior tibial perforator flap. Free flaps can be used in all regions. We describe the advantages and disadvantages, pearls, and tips of every flap. The coverage of the tibia after a major injury constitutes a reliable and versatile technique that should form part of the therapeutic arsenal of all the orthopedic surgeons, facilitating the integral treatment of complex lower limb injuries with exposed defects. Medknow Publications 2008 /pmc/articles/PMC2740344/ /pubmed/19753225 http://dx.doi.org/10.4103/0019-5413.43376 Text en © Indian Journal of Orthopaedics http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Rios-Luna, Antonio
Fahandezh-Saddi, Homid
Villanueva-Martínez, Manuel
López, Antonio García
Pearls and tips in coverage of the tibia after a high energy trauma
title Pearls and tips in coverage of the tibia after a high energy trauma
title_full Pearls and tips in coverage of the tibia after a high energy trauma
title_fullStr Pearls and tips in coverage of the tibia after a high energy trauma
title_full_unstemmed Pearls and tips in coverage of the tibia after a high energy trauma
title_short Pearls and tips in coverage of the tibia after a high energy trauma
title_sort pearls and tips in coverage of the tibia after a high energy trauma
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740344/
https://www.ncbi.nlm.nih.gov/pubmed/19753225
http://dx.doi.org/10.4103/0019-5413.43376
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