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Long-Term Results after Muscle-Rib Flap Transfer for Reconstruction of Composite Upper Limb Defects
Alexandru Georgescu, Prof, MD, PhD; Ileana Matei; Irina Capota; Filip Ardelean; Iuliu Hatieganu
University of Medicine, Clinic of Plastic Surgery and Reconstruction, Cluj Napoca, Romania

Introduction: Traumatic open fractures or their complications, as osteomyelitis and nonunion, represent the main etiology of bone defects. If soft tissue defects are also present, the management of these lesions becomes more challenging. The most used flaps in these cases are the vascularized fibula osteoseptocutaneous flap, the vascularized iliac osteocutaneous flap, and the vascularized muscular-rib flap. We previously reported about the advantages and the few complications by using the muscle-rib flap, and about the advantages of all-in-one reconstruction in complex injuries of the limbs involving both bone and soft tissue defects by using these flaps.
Material and Methods: The study refers to 23 patients operated for acute or sequelar traumatic composite bone and soft tissue defects in upper limb, between March 1997 and March 2011, 5 females and 18 males, with an average age of 30.5 years (range, 5 to 66 years). The etiology of the defects was an acute trauma in 11 cases, and a posttraumatic complication in 12 cases. The average length of the bone defect was 5.2cm (range, 3 to 8cm), and the surface of soft tissue defect ranged between 6 and 475sqcm. The flap used was serratus anterior-rib in 12 cases, the latissimus dorsi-rib in 6 cases, and the latissimus dorsi-serratus anterior-rib in the remaining 5 cases; from these, 17 were free flaps, and 6 pedicled flaps.
Results: The average follow-up in our 23 patients was 23.1 months (range, 12 to 48 months). We had complete flap survival in all the cases. In only one case we registered a superficial wound infection, which was solved conservatively. Regarding the long term results, we registered a rate of primary bone union of 100%, with an average time of 6.6 months.
Conclusions: The vascularized rib (s) as part of a composite flap represents a good indication, especially in bone defects associated with large soft tissue defects.


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