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Soft-Tissue Reconstruction of an Open Tibial Wound in the Distal Third of the Leg: A New Treatment Algorithm

Pu, Lee L. Q. MD, PhD, FACS

doi: 10.1097/
Advances in Plastic Surgery

Over the past 4 years, a total of 33 patients, each with an open tibial wound in the distal third of the leg, underwent a skin-grafted muscle flap reconstruction according to the new treatment algorithm developed by the author. When the size of the soft-tissue defect was less than 50 cm2, a pedicled medial hemisoleus muscle flap was used for the soft-tissue coverage (n = 20). If the soleus muscle was traumatized, a small free muscle flap (ie, gracilis) was then used (n = 3). When the size of the soft-tissue defect was greater than 50 cm2, a larger free muscle flap (ie, rectus abdominis or latissimus dorsi) was selected (n = 10). All patients were followed for up to 4 years. Three patients with a medial hemisoleus muscle flap developed insignificant distal flap necrosis and were treated subsequently with debridement and flap advancement. Five patients with a free muscle flap required an additional operation, and 2 patients had a subsequent debulking procedure of the flap for contour improvement of the leg. Reliable soft-tissue coverage with a well-healed tibial wound, evident fracture healing, and good contour of the leg were achieved in all 33 patients during follow-up. Following this new treatment algorithm, a selected option for an open tibial wound in the distal third of the leg can provide reliable soft-tissue coverage for different sizes of open tibial wounds and may offer a more cost-effective approach for managing such a complex clinical problem.

Thirty-three distal-third open pretibial wounds were successfully closed with hemisoleus or small free muscle flaps (defect <50 cm2) or larger free muscle flaps (defect >50 cm2). Revision procedures were required in 10 cases.

From the Division of Plastic Surgery, University of Kentucky, Lexington, KY.

Received September 21, 2006 and accepted for publication October 6, 2006.

Presented at the Annual Meeting of the American Society for Reconstructive Microsurgery, Tucson, AZ, January 14–17, 2006, and the 49th Annual Scientific Meeting of the Southeastern Society of Plastic and Reconstructive Surgeons, Sea Island, GA, June 4–8, 2006.

Reprints: Lee L. Q. Pu, MD, PhD, FACS, Division of Plastic Surgery, University of Kentucky, Kentucky Clinic, K454, Lexington, KY 40536-0284. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.