Arch Reconstr Microsurg.  2014 May;23(1):18-20.

Free Flap Transplantation in Open Tibial Fracture with Vessel Injury in the Elderly

  • 1Department of Orthopedic Surgery, Presbyterian Medical Center, Jeonju, Korea.
  • 2Department of Orthopedic Surgery, Chonbuk National University Medical School, Chonbuk National University and Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea.


Two aged patients who had open tibial fractures with arterial injury caused by high energy accidents underwent emergency arterial reconstruction using a greater saphenous vein and soft tissue repair using free flaps. In the patients, soft tissue necrosis developed and tibias were exposed at postoperative third week. Follow-up angiography through the superficial femoral artery showed occlusion of the anterior tibial artery. The anterior tibial artery was reconstructed using the contralateral greater saphenous vein graft and the latissimus dorsi myocutaneous and rectus abdominis muscle free flaps were transplanted for repair of necrotic soft tissue. The reconstructed arteries showed good perfusion to the new free flaps until union of the tibias occurred. The patients were followed-up for 21 years and 17 years postoperatively, respectively. In management of open comminuted fracture of the tibia, injury of the arterial system must be ruled out by angiography in addition to evaluation of the degree of soft tissue injury.


Open tibial fracture; Angiography; Latissimus dorsi myocutaneous free flap; Rectus abdominis muscle free flap
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