[Pedicle flap transfer combined with external fixator to treat leg open fracture with soft tissue defect].
OBJECTIVE
To investigate the clinical results of treating leg open fracture with soft tissue defect by pedicle flap transfer in combination with external fixator.


METHODS
From May 2004 to June 2007, 12 cases of leg open fracture with soft tissue defect, 9 males and 3 females aged 18-75 years, were treated. Among them, 8 cases were caused by traffic accidents, 2 crush, 1 falling and 1 mechanical accident. According to the Gustilo Classification, there were 2 cases of type II, 5 of type IIIA and 5 of type IIIB. There were 2 cases of upper-tibia fracture, 3 of middle-tibia and 7 of middle-lower. The sizes of soft tissue defect ranged from 5 cm x 3 cm to 22 cm x 10 cm.The sizes of exposed bone ranged from 3 cm x 2 cm to 6 cm x 3 cm. The course of the disease was 1-12 hours. Fracture fixation was reached by external fixators or external fixators and limited internal fixation with Kirschner wire. The wounds with exposed tendons and bones were repaired by ipsilateral local rotation flap, sural neurocutaneous flap and saphenous nerve flap. The size of selected flap ranged from 5 cm x 4 cm to 18 cm x 12 cm. Granulation wounds were repaired by skin grafting or direct suture.


RESULTS
All patients were followed up for 6 months to 2 years. All patients survived, among whom 2 with the wound edge infection and 1 with the distal necrosis were cured by changing the dressing, 8 with pin hole infection were treated by taking out the external fixator, 1 with nonunion received fracture healing after bone graft in comminuted fracture of lower tibia, 2 suffered delayed union in middle-lower tibia fracture. The ROM of ankle in 3 cases was mildly poor with surpass-joint fixation, with plantar extension of 0-10 degrees and plantar flexion of 10-30 degrees, while the others had plantar extension of 10-20 degrees and plantar flexion of 30-50 degrees.


CONCLUSIONS
The method of pedicle flap transfer combined with external fixator is safe and effective for the leg open fracture with soft tissue defect.
Luo
Zhongchun
Z
Department of Orthopaedics, People's Hospital of Leshan, Leshan Sichuan, PR China. lzs811120@yahoo.com.cn
Lou
Hua
H
Jiang
Junwei
J
Song
Chunlin
C
Gong
Min
M
Wang
Yongcai
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D001915:Braces; D016267:External Fixators; D005260:Female; D005597:Fractures, Open / Q000150:complications / Q000601:surgery*; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016038:Skin Transplantation; D017695:Soft Tissue Injuries / Q000150:complications / Q000601:surgery*; D013524:Surgical Flaps