Soft tissue reconstruction with reverse flow sural flap in pilon fractures

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 akýmlý sural flep ile yumuþak doku rekonstrüksiyonu

Amaç: Pilon fraktürleri yüksek enerjili travmalardan kaynaklanýr ve genellikle çevre yumuþak doku hasarý eþlik eder. Hastanýn genel durumu ve eþlik eden hastalýklarý haricinde, tibial bölgenin damarlanmasýnýn zayýf olmasý birçok vakada rekonstrüksiyonun zor olmasýna sebep olur.
Gereç ve Yöntemler: Ocak 2012 ile Aðustos 2015 tarihleri arasýnda Ortopedi Kliniði tarafýndan AO 43A-C pilon fraktürü nedeniyle tedavi edilen 8 hasta çalýþmaya alýndý. Hastalar kliniðimize operasyon alanýnda tam kat yumuþak doku defekti nedeniyle danýþýldý ve ters akýmlý sural flep ile rekonstrüksiyon uygulandý. Hastalar geriye dönük olarak; yaþ, etiyoloji, defekt çapý ve komplikasyonlar açýsýndan
incelendi.
Bulgular: Ocak 2012 ile Aðustos 2015 yýllarý arasýnda 8 hastaya (4 kadýn, 4 erkek) pilon fraktürü sonrasýnda geliþen yumuþak doku defekti nedeniyle ters akýmlý sural flep ile rekonstrüksiyon uygulandý. Postoperatif dönemde bir hastada parsiyel flep nekrozu izlendi ve sekonder iyileþme ile düzelirken, yara ayrýþmasý, total flep kaybý ve enfeksiyon gibi komplikasyonlar hiçbir hastada izlenmedi.
Sonuç: Pilon kýrýklarý ayak bileðinin komplikasyon oraný yüksek ve tedavisi en zor kýrýklarýndandýr. Sural flep; distal tibial bölgenin rekonstrüksiyonunda tek veya aþamalý olarak uygulanan güvenilir bir fleptir.