Department of Orthopedics, Buddhachinaraj Hospital, 90 Srithamtraipidok Road, Phitsanulok, 65000, Thailand.
Eur J Orthop Surg Traumatol. 2021 Feb;31(2):365-373. doi: 10.1007/s00590-020-02786-0. Epub 2020 Sep 5.
The role of internal fixation and local muscle flaps for open tibial fractures is still not specifically determined. We describe the integration of internal fixation and soleus muscle flap for open fractures complicated with soft tissue loss of the tibial shaft.
Twenty-seven patients with Gustilo IIIB open fractures of the tibial shaft were operated on by internal fixation and soft tissue coverage by soleus muscle flaps and variances. Data were collected on types of implants, types of flaps, union time, postoperative complications, and objective clinical measurement.
Regarding implants for fixation, plates and screws were selected in 22 patients, and intramedullary nails in 5. Proximally based soleus flap was used in 17 patients, hemisoleus in 6, and reversed hemisoleus in 4. All flaps survived and all fractures were united with a mean union time of 21.8 weeks (range 14-30). One patient had unplanned reoperations due to delayed union and equinus deformity of the ankle. All patients had good-to-excellent Puno functional score results.
Internal fixation and soft tissue coverage, frequently referred to as 'fix and flap', by a local soleus muscle flap is safe and effective for open fractures accompanied with small-to-medium size soft tissue defect of the tibial shaft.
对于开放性胫骨骨折，内固定和局部肌肉皮瓣的作用仍未明确。我们描述了内固定和比目鱼肌皮瓣联合应用于胫骨骨干伴软组织缺损的开放性骨折。
对 27 例胫骨骨干 Gustilo IIIB 型开放性骨折患者采用内固定和比目鱼肌皮瓣和变异肌瓣覆盖软组织，收集植入物类型、皮瓣类型、愈合时间、术后并发症和客观临床测量等数据。
22 例患者选择了钢板和螺钉固定，5 例患者选择了髓内钉固定。17 例患者采用了近端比目鱼肌皮瓣，6 例患者采用了半比目鱼肌皮瓣，4 例患者采用了逆行半比目鱼肌皮瓣。所有皮瓣均存活，所有骨折均愈合，平均愈合时间为 21.8 周（范围 14-30 周）。1 例患者因延迟愈合和踝关节马蹄畸形而计划再次手术。所有患者的 Puno 功能评分结果均良好至优秀。
内固定和软组织覆盖，通常称为“固定和皮瓣”，使用局部比目鱼肌皮瓣治疗胫骨骨干伴有小到中等大小软组织缺损的开放性骨折是安全有效的。
