title: Distally based sural fasciomusculocutaneous flap for treatment of wounds of the distal third of the leg and ankle with exposed internal hardware.
abstract: Soft tissue reconstruction of the distal third of the lower limb with exposure of the internal hardware is a challenging problem with several potential complications, such as exposure of the fracture line, fracture instability and bacterial contamination. The treatment of these lesions usually consists of substitution of the internal hardware with external fixation devices and further flap coverage. We propose a different reconstructive approach, characterized by harvesting a sural fasciomusculocutaneous flap on the exposed internal hardware once a sterile ground has been obtained. Four patients were retrospectively analyzed. Soft tissue reconstruction was achieved in all cases. In one case hardware removal was necessary for complete healing. The sural fasciomusculocutaneous flap is a safe alternative to other pedicled and free flaps. Moreover, it allows direct coverage of internal fixators, thus completing the reconstruction in less time. This flap fits best to the morphology of the wound and internal hardware, leaving the main vascular trunk of the leg intact and at the same time providing a reliable vascular supply.
authors.affiliation: Dipartimento di Scienze Medico Chirurgiche, Università degli Studi di Milano, IRCCS Policlinico San Donato, Piazza Malan, 20097 San Donato Milanese, Milan, Italy. luca.vaienti@unimi.it
authors.forename: Luca
authors.initials: L
authors.lastname: Vaienti
authors.forename: Adriano
authors.initials: A
authors.lastname: Di Matteo
authors.forename: Riccardo
authors.initials: R
authors.lastname: Gazzola
authors.forename: Pietro
authors.initials: P
authors.lastname: Randelli
authors.forename: Jlenia
authors.initials: J
authors.lastname: Lonigro
mesh_terms: D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000601:surgery; D005206:Fascia Lata / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery; D006801:Humans; D016268:Internal Fixators; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D013524:Surgical Flaps; D013848:Thigh; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014945:Wound Healing