title: Free flap reconstruction for infection of ankle fracture hardware: case report and review of the literature.
abstract: BACKGROUND
  Clinical management of orthopedic hardware infections related to ankle fracture fixation may present difficult therapeutic dilemmas. Typically, management includes removal of the hardware, debridement of necrotic tissue, and eventual placement of an alternative method of stabilization, usually, an external fixator or cast. However, problems arise when the fracture cannot be managed adequately with an external method. Such is the case with supination external rotation (SER) fractures, yet maintaining the hardware in the setting of infection typically is not considered an option.
  
  
  METHODS
  Case report and review of pertinent English-language literature.
  
  
  RESULTS
  The patient was a 47-year-old man with diabetes mellitus who sustained a type IV SER fracture that was treated with plate and screw fixation. Six weeks postoperatively, he presented with infection of the lateral ankle incision and the hardware. This was treated with debridement of the wound and dressing changes while leaving the hardware in place. It was decided to use a free muscle flap in an effort to preserve the ankle for a functional outcome versus the alternative of a below-knee amputation. With a free rectus abdominis flap, the lower extremity was preserved, and after four months, the patient was able to walk. One year postoperatively, the patient was ambulating without difficulty, and the hardware was still in place.
  
  
  CONCLUSIONS
  This report examines the dilemma of SER ankle fractures and how management strategies must be tailored to the individual situation. In some cases, the hardware must be considered essential to avoid below-knee amputation.
authors.affiliation: Aesthetic and Plastic Surgery Institute, University of California, Irvine, Orange, California 90822, USA. jay.calvert@med.va.gov
authors.forename: Jay W
authors.initials: JW
authors.lastname: Calvert
authors.forename: Som
authors.initials: S
authors.lastname: Kohanzadeh
authors.forename: Martin
authors.initials: M
authors.lastname: Tynan
authors.forename: Gregory R D
authors.initials: GR
authors.lastname: Evans
mesh_terms: D016512:Ankle Injuries / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001860:Bone Plates / Q000382:microbiology; D001863:Bone Screws / Q000382:microbiology; D003646:Debridement; D048909:Diabetes Complications; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*
chemical_list: D000900:Anti-Bacterial Agents