title: [Free muscle transplantation after complex fractures of the lower leg and ankle: results from 32 patients].
abstract: OBJECTIVE
  To describe the results of free vascularized muscle transfer for treatment of complications of severe open fractures of the distal tibia and ankle region.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  In 1994-1998, 32 patients underwent free muscle transfer for soft tissue reconstruction after high energy injury to the distal tibia and ankle region. In six patients reconstruction took place within one week after the injury (group 1); 13 patients underwent free muscle transfer in combination with (re)osteosynthesis and cancellous bone grafting for treatment of infected (defect) pseudarthrosis (group 2); chronic posttraumatic osteitis existed for an average of 12 years in six patients (group 3); in seven patients the indication was determined by unstable scar tissue, cosmetic reasons, or as preparation for corrective osteotomy (group 4).
  
  
  RESULTS
  Three haematomas and two thrombembolic complications were encountered. Amputation could not be avoided in three patients. Consolidation of the fracture, pseudarthrosis or arthrodesis and/or eradication of infection was accomplished in all remaining 29 patients. An average of 2.2 (range: 0-7) reinterventions were additionally needed in groups 1-3, including reosteosynthesis, sequestrectomy, cancellous bone grafting and/or arthrodesis.
  
  
  CONCLUSIONS
  In case of severe open fracture of the distal tibia and/or ankle region, free vascularized muscle transfer provided cover of the fracture or pseudarthrosis region, thereby improving local vascularisation. This treatment protects the underlying bone, enhances osteogenesis and improves resistance to infection.
authors.affiliation: Afd. Heelkunde, Academisch Ziekenhuis, Utrecht.
authors.forename: E A
authors.initials: EA
authors.lastname: te Velde
authors.forename: J B
authors.initials: JB
authors.lastname: Hulscher
authors.forename: P M
authors.initials: PM
authors.lastname: Werker
authors.forename: M
authors.initials: M
authors.lastname: Kon
authors.forename: C
authors.initials: C
authors.lastname: van Der Werken
mesh_terms: D000328:Adult; D000671:Amputation, Surgical; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D020127:Recovery of Function; D012189:Retrospective Studies; D013524:Surgical Flaps; D016042:Transplantation, Heterotopic; D014184:Transplantation, Homologous; D016896:Treatment Outcome