Interest of Fasciocutaneous and Muscular Flaps in the Management of Open Fractures of the Leg in Adults in the Orthopedics-Traumatology Department of the Ignace Deen University Hospital in Conakry
Keïta K1, Camara T1, Madjirabé NH1, Camara MB1, Bah ML1, Diallo MM2 and Lamah L2
1Department of Orthopedics-Traumatology of the CHU Ignace Deen
2Department of Orthopedics-Traumatology of CHU Donka
*Corresponding author: Tafsir Camara, Department of Orthopedics-Traumatology of the CHU Ignace Deen
Citation: Keita K, Camara T, Madjirabe NH, Camara MB, Bah ML, et al. Interest of fasciocutaneous and muscular flaps in the management of open fractures of the leg in adults in the Orthopedics-Traumatology department of the Ignace Deen University Hospital in Conakry. J Orthop Study Sports Med.1(1):1-8.
Received: August 12, 2023 | Published: September 2, 2023
Copyright© 2023 by Keita K. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Introduction: The reconstruction of substance loss in open fractures of the leg represents a challenge in Traumatology and has motivated the introduction of plastic recovery surgery. The objective of this work was to report the results of the management of open leg fractures in adults by providing fasciocutaneous and muscular flaps in our department.
Patients and methods: This was an observational, descriptive study, running from January 2018 to December 2020. It focused on adult patients seen for an open fracture of the leg with loss of cutaneous-muscular substance in whom a flap fascio-cutaneous or muscular was performed.
Results: We collected 15 patients with extensive losses of cutaneous-muscular substances, i.e. 1.2%. The average age was 35.2 years with a male predominance and a sex ratio of 2.75. The etiologies were dominated by road traffic accidents in 93.3%. Muscle flaps were performed in 66.7% and fascio-cutaneous flaps in 33.3%. The healing of the flap was obtained in 14 cases (93.3%) and we found 1 case of superficial necrosis of the flap.
Conclusion: Muscle and fascio-cutaneous flaps remain the best alternative in the management of extensive loss of cutaneous-muscular substance in open fractures of the leg.
Muscle flaps; Fasciocutaneous; Open fracture; Leg.
The open fracture of the leg is a solution of bone continuity associated with lesions of the soft tissues linking this bone and the ambient external environment . It testifies to a brutal trauma, often responsible for multi-tissue lesions that can affect the function of the limb; whatever the stage of opening, it remains a surgical emergency . Indeed, the treatment of open fractures of the leg requires the respect of certain unanimously recognized basic principles which are early antibiotic prophylaxis, adequate trimming, fixation, and early coverage of the fracture site . The reconstruction of substance loss in open fractures of the leg represents a challenge in Traumatology and has motivated the introduction of plastic surgery of recovery . Flap surgery consists in transposing tissues with autonomous vascularization from one anatomical region to another. She was born more than 2000 years ago, in India with Susruta .
The current therapeutic strategy gives priority to the secondarily grafted muscle flap which can be pedicled or free, depending on the configuration of the loss of substance. Fasciocutaneous flaps are structures that respect the anastomotic vascular networks located on either side of the fascia . The main problem lies in the indication of the type of flap. This decision-making is based on many arguments: the location and size of the loss of substance, the condition of the vessels, the patient's background, the surgeon's experience and the reconstruction time . In our Guinean context, this flap surgery is practiced more and more, however no previous study has yet been carried out in our department. Thus, the objective of this work was to report the results of the management of open fractures of the leg in adults by providing fasciocutaneous and muscular flaps in our department.
Patients and Methods
This was an observational, descriptive study lasting 36 months from January 2018 to December 2020. We targeted adult patients seen for an open leg fracture. The study population consisted of adult patients with an open fracture of the leg with loss of cutaneous-muscular substance. We included adult patients seen for an open fracture of the leg with loss of cutaneous-muscular substance in whom a fascio-cutaneous or muscular flap was performed. The data collected concerned: frequency, age, sex, etiologies, time to admission, Gustilo-Anderson classification, type of flap used and complications. Clinically, all the patients underwent a clinical examination to determine the etiology of the trauma, the time to admission and to assess the degree of skin opening (Figure 1). The Gustilo-Anderson classification [8-9] was used to type the soft tissue lesion.
Figure 1: Clinical image of the left leg showing Gustilo-Anderson open fracture type IIIB.
The digital X-ray of the leg concerned (face and profile) (Figure 2) was performed in all the patients, allowing the bone lesions to be described.
Figure 2: Initial X-ray of the left leg (F/P).
Therapeutically, all patients received spinal anesthesia. For cases of recent open fracture, we performed surgical debridement followed by reduction of the fracture site and placement of external fixators followed by initial coverage of the fracture site by adding a flap (Figure 3). Open fracture cases with significant deterioration, reducing the possibility of flap contribution, benefited from surgical debridement followed by reduction of the fracture site and placement of external fixators. The coverage of the hearth was made secondarily in these last cases. Fasciocutaneous flaps have been used in cases of open fracture of the lower third of the leg. As for muscle flaps, they were performed in cases of open fracture of the upper and middle thirds of the leg, exceptionally in cases of open fracture of the lower third with risk of infection. The skin graft was performed as a second intention after contribution of muscle flap. The healing of the flap (Figure 4) was obtained except in one case where we observed partial necrosis of the flap immediately postoperatively.