Reconstruction of Limited Soft-Tissue Defect With Open Tibial Fracture in the Distal Third of the Leg: A Cost and Outcome Study

Abstract

This study was conducted to analyze the cost and outcome of free-tissue transfers versus local muscle flaps for reconstruction of limited soft-tissue defects associated with tibial fractures in the distal third of the leg. Twelve adult patients underwent either free (n = 6) or local muscle (n = 6) flap reconstruction were retrospectively reviewed. Total operative time for local muscle flap reconstruction was 215 ± 47 minutes compared with 450 ± 90 minutes (P < 0.0002) for free-muscle transfer. Median length of hospital stay after reconstruction was 7 days for local muscle flap compared with 9 days for free-muscle transfer. Total cost of the local muscle flap procedure was $11,729 ± $4460 compared with $19,989 ± $3295 (P < 0.0004) for free-flap reconstruction. Five of 6 patients in each group had excellent soft-tissue contours. Fracture healing was evident in all patients of each group. Thus, a local muscle flap for reconstruction of a limited distal tibial wound appears to be more cost-effective than free-tissue transfer because of equivocal outcomes achieved but at approximately half of the cost.

In Brief

A comparison of 6 free flap and 6 local muscle flap reconstructions of distal-third leg open-fractures demonstrated twice the operative time, longer hospital stay, and greater cost with free flaps. All flaps healed satisfactorily.