title: Is delayed reconstruction using the latissimus dorsi free flap a worthy option in the management of open IIIB tibial fractures?
abstract: Early reconstruction of severe open fractures, performed within 7 days of the injury, has a better outcome than closure after 7 days. However, the uncertain demarcation of damaged tissue often results in delayed reconstruction. In this article, we report our surgical outcomes of delayed reconstruction using latissimus dorsi free flap with internal fixation. Twenty-three patients with Gustilo type IIIB open tibial fractures Between March 2009 and May 2012 were included in this study. There were 16 cases of distal 1/3 fracture of the tibia, 4 of midshaft fracture, 1 of proximal 1/3 fracture, and 2 of segmental fracture. Serial debridement with application of negative pressure wound therapy (NPWT) was performed before the final operation. All patients underwent internal fixation of the bone and reconstruction of soft tissue defect using latissimus dorsi free flap. The number of serial debridements, excluding those performed during emergency and finial operation, ranged from 1 to 5 (mean 2.69) times. Mean time from injury to final operation was 10.65 (range, 7-22) days. All flaps survived without complications. Three cases (13%) were infected, and three cases required further bone graft surgery to facilitate bone union (13%). Bone union was achieved after a mean 6.3 (range, 3-12) months. Mean follow-up period was 16.34 (range, 12-26) months. During follow-up, all patients were able to ambulate without use of an aid. In cases of severe open fracture, treatment should emphasize soft tissue coverage rather than rushing to achieve definitive fixation in the setting of poor surrounding tissues. When delayed reconstruction is inevitable, radical debridement is performed first, then NPWT is used as bridging therapy, and free flap could be considered for definite soft tissues coverage. © 2015 Wiley Periodicals, Inc. Microsurgery 36:453-459, 2016.
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, Korea.
authors.forename: Kyu Tae
authors.initials: KT
authors.lastname: Hwang
authors.affiliation: Department of Plastic and Reconstructive Surgery, Seoul National University, College of Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Sang Wha
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, Korea.
authors.forename: Il Hoon
authors.initials: IH
authors.lastname: Sung
authors.affiliation: Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea.
authors.forename: Jeong Tae
authors.initials: JT
authors.lastname: Kim
authors.affiliation: Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea. younhwank@daum.net.
authors.forename: Youn Hwan
authors.initials: YH
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D005597:Fractures, Open / Q000601:surgery*; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D064171:Superficial Back Muscles / Q000637:transplantation*; D013978:Tibial Fractures / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult