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European Journal of Orthopaedic Surgery & Traumatology
Erschienen in:

10.08.2024 | Original Article

Concurrent plate fixation and pedicled flap coverage for open fractures complicated by soft tissue loss of the tibia in pediatric cohort: a clinical series

verfasst von: Surasak Jitprapaikulsarn, Pasit Sengpanich, Ployphailin Rungsakaolert, Kritsada Sukha, Pissanu Reingrittha, Arthit Gromprasit

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 6/2024

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Abstract

Background

The optimal treatment of open fractures complicated by soft tissue loss of pediatric tibial fractures remains inconclusive. The author described a protocol of concurrent plate fixation and pedicled flap coverage and retrospectively reviewed the outcomes of such injuries.

Methods

A total of 25 pediatric cases with Gustilo lllB open tibial fracture were treated by single-stage plate fixation and pedicled flap reconstruction. The reviewed information consisted of time to fix and flap, type of plate, type of pedicled flap, fracture union time, postoperative complication and the clinical outcomes by objective scoring system.

Results

Fix and flap was undergone between 7 and 12 days after injury with the average time of 8.2 days. Regarding the type of plate, narrow LCP was applied in 8, 3.5 mm precontoured LCP in 10, 5.0 mm precontoured in 2 and double LCP in 5. According to soft tissue reconstruction, the medial gastrocnemius flap was selected in 6 cases, myocutaneous medial gastrocnemius flap in 2, soleus flap in 3, hemisoleus flap in 5, reverse sural flap in 6 and combined medial gastrocnemius and hemisoleus flaps in 3. No flap-related complication was demonstrated. All cases established fracture union in between 12 and 24 weeks with an average time to union of 17.7 weeks. According to postoperative complications, infected plate occurred in 2 cases and implant irritation in 5. According to Puno functional score, excellent results were presented in 7 cases and good results in 18 cases.

Conclusion

Single-stage plate fixation and pedicled flap coverage are a reliable regimen for pediatric open fractures complicated by soft tissue loss of the tibia.
Literatur
1.
Kubiak EN, Egol KA, Scher D, Wasserman B, Feldman D, Koval KJ (2005) Operative treatment of tibial fractures in children: are elastic stable intramedullary nails an improvement over external fixation? J Bone Joint Surg Am 87(8):1761–8
2.
Messner J, Harwood P, Johnson L, Itte V, Bourke G, Foster P (2020) Lower limb paediatric trauma with bone and soft tissue loss : Ortho-plastic management and outcome in a major trauma centre. Injury 51(7):1576–83
3.
Laine JC, Cherkashin A, Samchukov M, Birch JG, Frcs C, Rathjen KE (2016) The management of soft tissue and bone loss in type iiib and iiic pediatric open tibia fractures. J Pediatr Orthop 36(5):453–458CrossRefPubMed
4.
Heo J, Oh CW, Park KH, Kim JW, Kim HJ, Lee JC et. al.(2016) Elastic nailing of tibia shaft fractures in young children up to 10 years of age. Injury 47(4):832–6.
5.
Glass GE, Pearse M, Nanchahal J (2009) The ortho-plastic management of Gustilo grade IIIB fractures of the tibia in children : a systematic review of the literature. Injury 40(8):876–9.
6.
Lascombes P, Haumont T, Journeau P (2006) Use and abuse of flexible intramedullary nailing in children and adolescents. J Pediatr Orthop 26(6):827–834CrossRefPubMed
7.
Gougoulias N, Khanna A, Maffulli N (2009) Open tibial fractures in the paediatric population : a systematic review of the literature. Br Med Bull 91:75–85CrossRefPubMed
8.
Gopal S, Giannoudis PV, Murray A, Matthews SJ, Smith RM (2004) The functional outcome of severe, open tibial fractures managed with early fixation and flap coverage. J Bone Jt Surg Ser B 86(6):861–867CrossRef
9.
Jitprapaikulsarn S, Patamamongkonchai C, Gromprasit A, Thremthakanpon W (2021) Simultaneous internal fixation and soft tissue coverage by soleus muscle flap and variances: a reproducible strategy for managing open fractures of tibial shaft. Eur J Orthop Surg Traumatol 31(2):365–373CrossRefPubMed
10.
Jitprapaikulsarn S, Sukha K, Patamamongkonchai C, Gromprasit A (2021) Concurrent internal fixation and soft tissue reconstruction by distally based sural flap : a practicable scheme for complex distal tibial fractures. Eur J Orthop Surg Traumatol 31(4):711–8
11.
Jitprapaikulsarn S, Sukha K, Patamamongkonchai C, Gromprasit A (2022) Utilizing the various forms of the gastrocnemius muscle in fix and flap protocol : a reliable remedy for open proximal tibial fractures with accompanying soft tissue defect. Eur J Orthop Surg Traumatol 32(3):505–13
12.
Puno RM, Grossfeld SL, Henry SL, Seligson D, Harkess J, Tsai TM (1996) Functional outcome of patients with salvageable limbs with grades III-B and III-C open fractures of the tibia. Microsurgery 17(3):167–173CrossRefPubMed
13.
Messner J, Johnson L, Taylor DM, Harwood P, Britten S, Foster P (2018) Treatment and functional outcomes of complex tibial fractures in children and adolescents using the Ilizarov method. Bone Joint J 100-B(3):396–403
14.
Gordon JE, Gregush ÞR V, Schoenecker PL, Dobbs MB, Luhmann SJ (2007) Complications after titanium elastic nailing of pediatric tibial fractures. J Pediatr Orthop 27(4):442–6.
15.
Ueno M, Yokoyama K, Nakamura K (2006) Early unreamed intramedullary nailing without a safety interval and simultaneous flap coverage following external fixation in type IIIB open tibial fractures : A report of four successful cases. Injury 37(3):289–294CrossRefPubMed
16.
Hertel R, Lambert SM, Müller S, Ballmer FT, Ganz R (1999) On the timing of soft-tissue reconstruction for open fractures of the lower leg. Arch Orthop Trauma Surg 119(1–2):7–12CrossRefPubMed
17.
Godina M, Lister G (1986) Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg 78:285–292CrossRefPubMed
18.
Wood T, Sameem M, Avram R, Bhandari M (2012) A systematic review of early versus delayed wound closure in patients with open fractures requiring flap coverage. J Trauma Acute Care Surg 72(4):1078–1085CrossRefPubMed
19.
Clegg DJ, Rosenbaum PF, Harley BJ (2019): The effects of timing of soft tissue coverage on outcomes after reconstruction of type iiib open tibia fractures. Orthopedics 42(5):260–6.
20.
Dhamangaonkar AC, Patankar HS (2014) Reverse sural fasciocutaneous flap with a cutaneous pedicle to cover distal lower limb soft tissue defects: experience of 109 clinical cases. J Orthop Traumatol 15(3):225–229CrossRefPubMedPubMedCentral
21.
Zhang FH, Chang SM, Lin SQ, Song YP, Zheng HP, Lineaweaver WC et al (2005) Modified distally based sural neuro-veno-fasciocutaneous flap: anatomical study and clinical applications. Microsurgery 25(7):543–550CrossRefPubMed
22.
Song P, Pu LLQ (2018) The soleus muscle flap: an overview of its clinical applications for lower extremity reconstruction. Ann Plast Surg 81(6S Suppl 1):S109–S16
23.
Daigeler A, Drücke D, Tatar K, Homann HH, Goertz O, Tilkorn D et al (2009) The pedicled gastrocnemius muscle flap: a review of 218 cases. Plast Reconstr Surg 123(1):250–257CrossRefPubMed
24.
Mayoly A, Mattei JC, Moullot P, Jaloux C, Rochwerger A, Casanova D et al (2018) Gastrocnemius myocutaneous flaps for knee joint coverage. Ann Plast Surg 81(2):208–214CrossRefPubMed
25.
Pu LLQ (2010) Soft-tissue coverage of an extensive mid-tibial wound with the combined medial gastrocnemius and medial hemisoleus muscle flaps: the role of local muscle flaps revisited. J Plast Reconstr Aesthetic Surg 63(8):e605–e610CrossRef
26.
Jitprapaikulsarn S, Benjawongsathien K, Patamamongkonchai C, Gromprasit A, Thremthakanpon W (2021) Combined medial gastrocnemius and hemisoleus flap: a reproducible alternative for open tibial fractures complicated with large or double soft tissue defects. Eur J Orthop Surg Traumatol 31(2):413–420CrossRefPubMed
Metadaten
Titel
Concurrent plate fixation and pedicled flap coverage for open fractures complicated by soft tissue loss of the tibia in pediatric cohort: a clinical series
verfasst von
Surasak Jitprapaikulsarn
Pasit Sengpanich
Ployphailin Rungsakaolert
Kritsada Sukha
Pissanu Reingrittha
Arthit Gromprasit
Publikationsdatum
10.08.2024
Verlag
Springer Paris
Erschienen in
European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 6/2024
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-024-04059-6

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