title: Medial gastrocnemius muscle flap for treating wound complications after double-plate fixation via two-incision approach for complex tibial plateau fractures.
abstract: BACKGROUND
  In medical literature, few articles have reported the treatment of wound complications occurring after double-plate fixation via a two-incision approach for complex tibial plateau fractures. A retrospective study was conducted to evaluate the efficacy of a medial gastrocnemius muscle flap transfer in treating this complicated disability.
  
  
  METHODS
  We treated 16 consecutive adult patients, including 6 cases of wound complications without previous deep infection and 10 cases of wound complications with deep wound infection. A one-stage medial gastrocnemius muscle flap transfer was performed after excision of gangrened eschar in cases with wound complication after fracture fixation without infection. A staged flap transfer was performed after debridement and antibiotic administration in cases with wound complication after fracture fixation and wound infection. Bone grafting supplementation was performed in cases where a sequestrectomy had been performed.
  
  
  RESULTS
  All 16 patients were followed up for an average of 31 months (range, 13-50 months). The wound complications were successfully treated in 93.8% (15/16) of patients by medial gastrocnemius flap transfer. The fracture healed in 93.8% (15/16) of patients within an average period of 17.2 weeks (range, 10-51 weeks). One patient had gastrocnemius muscle necrosis with fracture nonunion and was treated with free vascularized muscle and osseous flap transfers. Knee function was satisfactory in 62.5% (10/16) of patients.
  
  
  CONCLUSIONS
  Medial gastrocnemius muscle flap transfer is a reliable technique for treating wound complications that occur after double-plate fixation via a two-incision approach in the treatment of complex tibial plateau fractures. A high success rate of wound healing with bone union can normally be achieved. We, therefore, recommend its widespread use in candidate patients.
authors.affiliation: From the Department of Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Hsin Street, 333, Taoyuan, Taiwan. enjoycu@ms22.hinet.net
authors.forename: Ying-Chao
authors.initials: YC
authors.lastname: Chou
authors.forename: Chi-Chuan
authors.initials: CC
authors.lastname: Wu
authors.forename: Yi-Sheng
authors.initials: YS
authors.lastname: Chan
authors.forename: Chung-Hsun
authors.initials: CH
authors.lastname: Chang
authors.forename: Yung-Heng
authors.initials: YH
authors.lastname: Hsu
authors.forename: Yu-Chih
authors.initials: YC
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D003646:Debridement; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D005596:Fractures, Closed / Q000601:surgery; D005597:Fractures, Open / Q000601:surgery; D006801:Humans; D007718:Knee Injuries / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D017695:Soft Tissue Injuries / Q000601:surgery; D013524:Surgical Flaps; D013978:Tibial Fractures / Q000150:complications / Q000601:surgery*; D014945:Wound Healing; D014946:Wound Infection / Q000601:surgery