Manas Raj Kumar, Chinta Kavya
Department of Plastic, Reconstructive & Burns Surgery, All India Institute of Medical Sciences, New Delhi, India.
Plast Surg (Oakv). 2024 Feb;32(1):148-152. doi: 10.1177/22925503221085371. Epub 2022 Mar 30.
Bilateral defects around the knee joint following fracture of the proximal tibia (Schatzker type V & VI) are difficult to reconstruct because of the unavailability of local tissue. A bicondylar proximal tibial fracture requires a bilateral approach and dual plates for fracture fixation. Because of extensive dissection during plating and extended zone of trauma, the suture lines occasionally dehisce resulting in soft tissue defects on both sides of the proximal tibia. Because of its bilateral nature, the defect requires 2 flaps. We are reporting 2 cases of suture dehiscence after fixation of bicondylar fracture of the proximal tibia which required reconstruction with bilateral gastrocnemius flaps. This reconstruction is a simple option that helps in providing stable coverage. The first case was followed up for a period of 5 years and the second case was followed up for a minimum period of 6 months. Both cases demonstrated well-healed flaps, united bone and no donor side morbidity. Bilateral gastrocnemius muscle flaps can be used simultaneously for 2 separate defects on both sides of the knee without significant donor site morbidly. This reconstructive option provides stable coverage, reduces the infection and promotes bony union thus helping in early ambulation.
胫骨近端骨折(Schatzker V型和VI型)后膝关节周围的双侧缺损因局部组织无法利用而难以重建。双髁胫骨近端骨折需要双侧入路和双钢板进行骨折固定。由于钢板固定期间的广泛解剖和创伤范围扩大,缝合线偶尔会裂开,导致胫骨近端两侧出现软组织缺损。由于缺损的双侧性,需要2个皮瓣。我们报告2例胫骨近端双髁骨折固定后缝合裂开的病例,这需要用双侧腓肠肌皮瓣进行重建。这种重建是一种简单的选择,有助于提供稳定的覆盖。第一例随访5年,第二例至少随访6个月。两例均显示皮瓣愈合良好、骨愈合且供区无并发症。双侧腓肠肌肌皮瓣可同时用于膝关节两侧的2个独立缺损,且供区无明显并发症。这种重建选择提供稳定的覆盖,减少感染并促进骨愈合,从而有助于早期行走。