DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20195612

Thoracic limb salvage by fibular free flap

Rodrigo Banegas Ruiz, Alan I. Valderrama Treviño, Francisco Fabián Gómez Mendoza, Rodrigo A. Mendoza Aceves, Rigoberto Román Hernández, Ismael Vejar Alba, Fernando Gómez Verdejo, José Antonio Rivas Montero, Karolina Ortega López, Yuri Jiménez Caprielova, Leonel Dalain Hernández Arteaga, Emilio Pérez Ortega, Baltazar Barrera Mera

Abstract


The treatment of most fractures of the ulna and radius is usually performed by anatomical reduction and internal fixation, when damage is extensive and local soft tissue cannot provide a complete wound coverage, locoregional flaps present a suitable reconstructive benefit. A 35-year-old male patient suffered an exposed diaphysio-metaphyseal fracture with multi-fragmented distal radius. The patient was evaluated during a 10-day period at the National Institute of Rehabilitation, where the osteosynthesis material and a severe infectious process with necrosis were identified. Necrosectomy of the posterior compartment and removal of the osteosynthesis material was performed, a skin defect of approximately 22x16 cm was observed with a bone gap of 6 cm of radius and ulna. a fibula-free flap is placed to correct the skin defect and an external fixative used for bone alignment. The fibular free flap presents an excellent therapeutic alternative in the resolution of bone gaps with extensive skin defect. Whenever a trained microsurgery team is available, current scales of limb injury should be considered but not utilized for therapeutic approach, always trying to shift amputation as the first option, to the very last one of them.


Keywords


Amputation, Complex trauma, Fibular free flap, Fracture, Microsurgery, Microvascular flap

Full Text:

PDF

References


Robert W, Bucholz MJDH. Rockwood and Green's Fractures in Adults. 6th ed. Lippincott Williams and Wilkins; 2005: 2512.

Duart J, Romero Muñoz LM, Flórez Álvarez B, Amillo S. Forearm fractures: functional result after open reduction and osteosynthesis. 2018;234(44):55-9.

Amoros Macad JM. Fracturas diafisarias de cúbito y radio Tratamiento y complicaciones. Rev Esp Cir Ost. 1979;14:105-115.

Tosti R, Eberlin KR. Damage control hand surgery: Evaluation and emergency management of the mangled hand. Hand Clin. 2018 Feb 1;34(1):17-26.

Prasarn ML, Helfet DL, Kloen P. Management of the mangled extremity. Strateg Trauma Limb Reconstruct. 2012 Aug 1;7(2):57-66.

Anderson LD, Sisk D, Tooms RE, Park W I. Compression-plate fixation in acute diaphyseal fractures of the radius and ulna. J Bone Joint Surg. 1975;57-A:287-7.

Schemitsch E, Richards R. The effect of malunion on functional outcome after plate fixation of. J Bone Joint Surg Am. 1992;74:1068-78.

Zalavras CG, Patzakis MJ, Holtom PD, Sherman R. Managment of Open Fractures. Infect Dis Clin N Am. 2005;19:915-29.

Collin T, Sugden P, Ahmed O, Ragbir M. Technical considerations of fibular osteocutaneous flap dissection. J Plastic Reconstruct Aesthetic Surg. 2008 Dec 1;61(12):1503-6.

de la Parra-Márquez M, Zorola-Tellez O, Cárdenas-Rodríguez S, Rangel-Flores JM, Sánchez-Terrones G. Versatilidad del colgajo microvascular de peroné en reconstrucción de extremidades. Cirugía Cirujanos. 2016 May 1;84(3):213-9.

Tantry TP, Kadam D, Shenoy SP, Bhandary S, Adappa KK. Perioperative evaluation and outcomes of major limb replantations with ischemia periods of more than 6 hours. J Reconstruct Microsurg. 2013 Mar;29(03):165-72.

Pet MA, Morrison SD, Mack JS, Sears ED, Wright T, Lussiez AD, et al. Comparison of patient-reported outcomes after traumatic upper extremity amputation: Replantation versus prosthetic rehabilitation. Injury. 2016 Dec 1;47(12):2783-8.

Otto IA, Kon M, Schuurman AH, Van Minnen LP. Replantation versus prosthetic fitting in traumatic arm amputations: a systematic review. PloS One. 2015 Sep 4;10(9):e0137729.

Ozalp T, Masquelet AC, Begue TC. Septocutaneous perforators of the peroneal artery relative to the fibula: anatomical basis of the use of pedicled fasciocutaneous flap. Surg Radiol Anatomy. 2006 Mar 1;28(1):54-8.