A reconstruction surgery is frequently needed in a lower limb trauma. It is a contentious issue which type of transfer technique and tissue should be used for wound coverage in lower limb, especially in tibial area. In this study, we tried to compare the utility of delayed reconstruction between free flaps and local propeller flaps for Gustilo type IIIB open tibial fractures with needed soft tissue coverage.
Patients were selected between February 2011 and June 2013.A total of 35 patients (32 males and 3 females) with traumatic open tibial fractures underwent reconstruction surgery and were retrospectively analyzed to compare anterolateral thigh free flap (17 males and 2 females) and local propeller flap (15 males and 1 female). In these series, all cases were treated by a delayed reconstruction because of the patients’ life threatening trauma and accompanying diseases. According to patients’ chart, the etiology and results were reviewed and statistically verified to find out a significant conclusion for both groups.
In t-test and rank sum test, there were significant statistical meanings in defect size, operation time, and ICU days after operation between two groups. Also, there was a meaningful statistical result that the inflammation marker was less elevated through 3 days after operation in the local propeller group than in the free flap group.
From this point of view, local propeller flap is useful method of reconstruction for patients with an open tibia fracture Gustilo type IIIb with a small size of defect in the mid-proximal tibia area and with an underlying medical disease who are vulnerable to a long operation time and inflammation after operation. It is possible to assume that an operation with local propeller flaps may be better tolerable for patients with medical comorbidities including tobacco usage, diabetes mellitus, hypertension, end stage renal disease and so on.
