Abstract
Introduction: Open fractures with severe soft tissue damage, uncovered osteosynthesis material and chronic soft tissue defect due to infection as well as its consequences represent a special challenge for the therapeutic strategy.
In these cases the soft tissue coverage has a particular importance.
Patients: Within a 24-month period (2005 to 2006) 145 open fractures of the lower leg and foot were treated. 34 of these showed a 1 °, 74 a 2 ° and 37 patients with 3 ° soft tissue damage. Furthermore, data on 16 patients with chronic soft tissue defect by infection, which had a flap coverage, have been evaluated.
Score: The average age was 43.3 years (6 to 68), the ratio of women to men 2:1. Primary definitive osteosynthesis was performed in 68 patients (47%). In 19 patients a local muscle flaps plastic (Soleus, Gastrocnemius, peroneus brevis) was carried out. Three of these were already covered in the context of the primary treatment. Fasciocutaneous flaps were performed in 17 patients.
In the most cases the defect site was closed by primary would healing, additional procedures (excision of skin necrosis, mesh grafting) were necessary in 8 cases. In one case we saw a complete loss of the muscle flap.
Conclusion: In addition to an adequate diagnosis (X-Rays, MRI) the soft tissue reconstruction of acute or chronic soft tissue defects, where the osteosynthesis material or the septic bone is uncovered, is also necessary. In the lower extremities local muscle flaps (M. soleus, M. gastrocnemius) or for smaller defects fasciocutaneous flaps (suralis) are particularly suitable.
Correspondence should be addressed to Vienna Medical Academy, Alser Strasse 4, A-1090 Vienna, Austria. Phone: +43 1 4051383 0, Fax: +43 1 4078274, Email: ebjis2009@medacad.org
