Medial Gastrocnemius Muscle Flap for Treating Wound Complications After Double-Plate Fixation via Two-Incision Approach for Complex Tibial Plateau Fractures

Abstract

Background: 

In medical literature, few articles have reported the treatment of wound complications occurring after double-plate fixation via a two-incision approach for complex tibial plateau fractures. A retrospective study was conducted to evaluate the efficacy of a medial gastrocnemius muscle flap transfer in treating this complicated disability.

Methods: 

We treated 16 consecutive adult patients, including 6 cases of wound complications without previous deep infection and 10 cases of wound complications with deep wound infection. A one-stage medial gastrocnemius muscle flap transfer was performed after excision of gangrened eschar in cases with wound complication after fracture fixation without infection. A staged flap transfer was performed after debridement and antibiotic administration in cases with wound complication after fracture fixation and wound infection. Bone grafting supplementation was performed in cases where a sequestrectomy had been performed.

Results: 

All 16 patients were followed up for an average of 31 months (range, 13–50 months). The wound complications were successfully treated in 93.8% (15/16) of patients by medial gastrocnemius flap transfer. The fracture healed in 93.8% (15/16) of patients within an average period of 17.2 weeks (range, 10–51 weeks). One patient had gastrocnemius muscle necrosis with fracture nonunion and was treated with free vascularized muscle and osseous flap transfers. Knee function was satisfactory in 62.5% (10/16) of patients.

Conclusion: 

Medial gastrocnemius muscle flap transfer is a reliable technique for treating wound complications that occur after double-plate fixation via a two-incision approach in the treatment of complex tibial plateau fractures. A high success rate of wound healing with bone union can normally be achieved. We, therefore, recommend its widespread use in candidate patients.