Soft tissue reconstruction with reverse flow sural flap in pilon fractures
Selami Serhat Sirvan1, Kamuran Zeynep Sevim1, Mehmet Mesut Sönmez2, Işıl Akgün Demir1, Daghan Dagdelen3, Fatih Irmak1, Sevgi Kurt Yazar4, Semra Karsidag11University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul - Turkey2University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Department of Orthopedic Surgery, Istanbul - Turkey
3Balikesir Governmental Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Balikesir - Turkey
4University of Health Sciences, Samatya Training and Research Hospital, Plastic Reconstructive and Aesthetic Surgery, Istanbul - Turkey
Objective: Pilon fractures are usually caused by high-energy traumas and associated with surrounding soft tissue damage. In addition to the patient’s medical state and comorbidities, the poor vascular supply of the distal tibia makes the reconstruction challenging in most of the cases.
Material and Methods: Eight patients with pilon fractures (AO types 43A-C) who were treated by the orthopaedics clinic between January 2012 and August 2015 were included in the study. These patients were consulted to our clinic due to full thickness soft tissue defect at the affected site during the operation, and were treated with reverse flow sural flap. Patients were analyzed retrospectively in terms of age, etiology, size of defect and postoperative complications.
Results: Between January 2012 and August 2015, 8 patients (4 females, 4 males) aged between 7 and 88 years (mean age: 46 years) underwent soft tissue reconstruction with reverse flow sural flap, due to tissue defect occurred after the pilon fracture. In the postoperative period, complications such as wound dehiscence, flap loss and infection were not encountered in any patients except one, who developed partial soft tissue necrosis and healed by secondary intention.
Conclusion: Pilon fractures are among the most difficult fractures of the ankle to treat, and have a high complication rate. Sural flap is a reliable way to reconstruct distal tibial defects in single or multiple-stage approaches.
Pilon fraktürlerinde ters akımlı sural flep ile yumuşak doku rekonstrüksiyonu
Selami Serhat Sirvan1, Kamuran Zeynep Sevim1, Mehmet Mesut Sönmez2, Işıl Akgün Demir1, Daghan Dagdelen3, Fatih Irmak1, Sevgi Kurt Yazar4, Semra Karsidag11University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul - Turkey2University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Department of Orthopedic Surgery, Istanbul - Turkey
3Balikesir Governmental Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Balikesir - Turkey
4University of Health Sciences, Samatya Training and Research Hospital, Plastic Reconstructive and Aesthetic Surgery, Istanbul - Turkey
Amaç: Pilon fraktürleri yüksek enerjili travmalardan kaynaklanır ve genellikle çevre yumuşak doku hasarı eşlik eder. Hastanın genel durumu ve eşlik eden hastalıkları haricinde, tibial bölgenin damarlanmasının zayıf olması birçok vakada rekonstrüksiyonun zor olmasına sebep olur.
Gereç ve Yöntemler: Ocak 2012 ile Ağustos 2015 tarihleri arasında Ortopedi Kliniği tarafından AO 43A-C pilon fraktürü nedeniyle tedavi edilen 8 hasta çalışmaya alındı. Hastalar kliniğimize operasyon alanında tam kat yumuşak doku defekti nedeniyle danışıldı ve ters akımlı sural flep ile rekonstrüksiyon uygulandı. Hastalar geriye dönük olarak; yaş, etiyoloji, defekt çapı ve komplikasyonlar açısından
incelendi.
Bulgular: Ocak 2012 ile Ağustos 2015 yılları arasında 8 hastaya (4 kadın, 4 erkek) pilon fraktürü sonrasında gelişen yumuşak doku defekti nedeniyle ters akımlı sural flep ile rekonstrüksiyon uygulandı. Postoperatif dönemde bir hastada parsiyel flep nekrozu izlendi ve sekonder iyileşme ile düzelirken, yara ayrışması, total flep kaybı ve enfeksiyon gibi komplikasyonlar hiçbir hastada izlenmedi.
Sonuç: Pilon kırıkları ayak bileğinin komplikasyon oranı yüksek ve tedavisi en zor kırıklarındandır. Sural flep; distal tibial bölgenin rekonstrüksiyonunda tek veya aşamalı olarak uygulanan güvenilir bir fleptir.
Manuscript Language: English