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Simultaneous internal fixation and soft tissue coverage by soleus muscle flap and variances: a reproducible strategy for managing open fractures of tibial shaft

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Funding

There was no source of funding for this research.

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Authors and Affiliations

  1. Department of Orthopedics, Buddhachinaraj Hospital, 90 Srithamtraipidok Road, Phitsanulok, 65000, Thailand

    Surasak Jitprapaikulsarn, Chawanan Patamamongkonchai, Arthit Gromprasit & Witoon Thremthakanpon

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  1. Surasak Jitprapaikulsarn
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  2. Chawanan Patamamongkonchai
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  3. Arthit Gromprasit
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  4. Witoon Thremthakanpon
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Contributions

SJ were involved in drafting and revising the manuscript for content, including medical writing for content, study concept and design, analysis and interpretation of data, as well as acquisition of the data. CP, AG and WT were involved in revising the manuscript for content and analysis and interpretation of data.

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Correspondence to Surasak Jitprapaikulsarn.

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Conflict of Interest

S. Jitprapaikulsarn, C Patamamongkonchai, A. Gromprasit and W. Thremthakanpon declare that they have no conflict of interest.

Ethical approval

This study has been approved by the ethical committees of Buddhachinaraj Hospital in accordance with the Declaration of Helsinki.

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Jitprapaikulsarn, S., Patamamongkonchai, C., Gromprasit, A. et al. Simultaneous internal fixation and soft tissue coverage by soleus muscle flap and variances: a reproducible strategy for managing open fractures of tibial shaft. Eur J Orthop Surg Traumatol 31, 365–373 (2021). https://doi.org/10.1007/s00590-020-02786-0

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  • DOI: https://doi.org/10.1007/s00590-020-02786-0

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