Muscle-Rib Flap For Upper Extremity Bone Defects
Georgescu Valentin Alexandru, Prof, MD, PhD
Plastic Surgery and Reconstructive Microsurgery Clinic, UMF Iuliu Hatieganu, Cluj Napoca, Romania
HYPOTHESIS Traumatic open fractures or their complications, as osteomyelitis and nonunion, represent the main aetiology 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 muscle-rib flap. We will report 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.
METHODS The study refers to 32 patients operated for acute or sequelar traumatic composite bone and soft tissue defects in upper limb, between March 1997 and March 2021, 8 females and 24 males, with an average age of 30,5 years (range, 5 to 66 years). The etiology of the defects was an acute trauma in 17 cases, and a posttraumatic complication in 15 cases. The average length of the bone defect was 5,2 cm (range, 3 to 8 cm), and the surface of soft tissue defect ranged between 6 and 475 cm2. The flap used was the SA-R in 14 cases, the LD-R in 11 cases, and the LD-SA-R in the remaining 7 cases; from these, 23 were free flaps, and 9 pedicled flaps.
RESULTS The average follow-up in our 32 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.
SUMMARY 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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