J Korean Fract Soc.  2015 Oct;28(4):256-265. 10.12671/jkfs.2015.28.4.256.

Reconstruction of a Traumatic Soft Tissue Defect

• Park JW

• KMID: 2070353
• DOI: http://doi.org/10.12671/jkfs.2015.28.4.256

Abstract

Soft tissue defect combined with an open fracture is a very challenging problem to the orthopaedic surgeon. Many complicated open fractures remain with soft tissue defect, chronic osteomyelitis, and sometimes terminate with major limb amputation. Soft tissue defect should be reconstructed as soon as possible, particularly when the bone, tendon, or neurovascular structures are exposed. Exposure for longer than a week significantly increases the risk of secondary infection and tissue necrosis. For the simple soft tissue defect, negative pressure wound closure technology has been introduced and many superficial wounds have been treated successfully using this method. For the more complicated wounds, many kinds of local flaps, pedicled flaps, muscle and fascisocutaneous flaps can be indicated according to the characteristics of the wounds. The free flaps including free vascularized bone graft can be considered as a final choice for the most difficult wound problems. In this article, various reconstruction strategies for soft tissue defect after traumatic open fracture are reviewed.

Keyword

Reconstruction; Soft tissue; Trauma; Fracture; Open wound

MeSH Terms

Amputation
Coinfection
Extremities
Fractures, Open
Free Tissue Flaps
Necrosis
Osteomyelitis
Surgical Flaps
Tendons
Transplants
Wounds and Injuries

Figure

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  Fig. 1 Open fracture around the knee joint. (A) Necrosis of patella and loss of patella tendon. (B) After debridement, the knee joint is opened and reconstruction of quadriceps mechanism is required. (C) Medial gastrocnemius muscle flap and saphenous neurocutaneous island flap are harvested. (D, E) The gastrocnemius muscle is turned to be sutured to the quadriceps muscle. (F) The remaining defect is covered with the saphenous neurocutaneous island flap. (G) Two years later, full range of motion of the knee joint is recovered and the motor grade reaches grade 4.

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  Fig. 2 Reverse sural artery flap. (A) Soft tissue defect at the posterior aspect of the ankle. (B) Reverse sural artery flap is designed. (C) Pedicled flap is dissected. (D) After completion of flap insetting.

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  Fig. 3 Anterolateral thigh (ALT) flap. (A) Contaminated soft tissue defect on the anterior ankle. (B) ALT flap is designed. (C) Dissected ALT flap. (D) Flap insetting. (E) Donor site is primarily closed. (F) Two months after the operation.

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  Fig. 4 Free vascularized fibular osteocutaneous flap. (A) Large tibia and soft tissue defect after infected open fracture. (B) Sequestrum is removed. (C, D) Free vascularized fibular graft is harvested from the ipsilateral leg. (E) Flap is fixed and repaired. (F) Two years after bone and soft tissue reconstruction.

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