title: Combined pedicled flaps for grade IIIB tibial fractures in children: a report of two patients.
abstract: Severe open tibial fractures in children are associated with notable morbidity and require early aggressive management to ensure a successful outcome. Free flaps are currently the gold standard in distal extremity reconstruction in which large soft-tissue defects exist, as is often the case with grade IIIB fractures. In severe lower limb trauma, however, free flaps are associated with a relatively high risk of failure, particularly when definitive soft-tissue coverage is delayed. Alternative methods of soft-tissue reconstruction may, therefore, occasionally require consideration. The authors describe the combined use of three pedicled flaps to attain soft-tissue coverage in 2 children with grade IIIB tibial fractures. These three flaps are individually in common use for lower limb soft-tissue coverage, are simple to raise, and in combination can cover extensive soft-tissue defects of the lower extremity. The major vascular axes of the limb are not sacrificed; however, the aesthetic result is modest.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Groote Schuur Hospital, and the University of Cape Town, South Africa.
authors.forename: P J
authors.initials: PJ
authors.lastname: Skoll
authors.forename: D A
authors.initials: DA
authors.lastname: Hudson
mesh_terms: D002648:Child; D002675:Child, Preschool; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps; D013978:Tibial Fractures / Q000601:surgery*