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Muscle-Rib Flap Transfer for Reconstruction of Composite Upper Limb Defects
Georgescu Valentin Alexandru, Prof, MD, PhD
Plastic Surgery and Reconstructive Microsurgery Clinic, Rehabilitation Hospital, Cluj Napoca, Cluj, Romania
Introduction: Direct traumatic open fractures or their complications 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 vascularised fibula osteoseptocutaneous flap, the vascularised iliac osteocutaneous flap, and the vascularised muscle-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 in complex injuries of the limbs involving both bone and soft tissue defects by using these flaps.
Material and 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 2023, 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 5.2cm (range, 3 to 8cm), and the surface of soft tissue defect ranged between 6 and 475sqcm. The flap used was the serratus anterior-rib in 14 cases, the latissimus dorsi-rib in 11 cases, and the latissimus dorsi-serratus anterior-rib in the remaining 7 cases; 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 consevatively. Regarding the long-term results, we registered a rate of bone union in 100%, with an average time of 6.6 months.
Conclusions: The vascularised rib(s) as part of a composite flap represents a good indication in bone defects associated with large soft tissue defects.
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