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The Use of Free Flaps in the Management of Type IIIB Open Calcaneal Fractures

Ulusal, Ali Engin M.D.; Lin, Chih-Hung M.D.; Lin, Yu-Te M.D.; Ulusal, Betul Goze M.D.; Yazar, Sukru M.D.

Plastic and Reconstructive Surgery: June 2008 - Volume 121 - Issue 6 - p 2010-2019
doi: 10.1097/PRS.0b013e3181712333
Reconstructive: Lower Extremity: Original Articles

Background: There have been a limited number of reports regarding calcaneal open fractures so far. Thus, the debate regarding treatment is continuing. Type IIIB open calcaneal fractures are often associated with the possibility of chronic osteomyelitis that may cause severe complications, including amputation.

Methods: Between the years 1990 and 2001, 27 free tissue transfers were performed in 25 patients for reconstruction of soft-tissue defects complicated by calcaneal fracture. All of the patients underwent debridement and bone fixation procedures at the initial operation in the acute phase. Ten patients with comminuted fractures were treated by means of external fixation and 15 patients had intraarticular fractures that required internal fixation in addition to external fixation. After several aggressive debridements, free tissue transfers were performed subacutely for primary wound coverage. Muscle flaps were used in the majority of cases (n = 21). The mean follow-up period was 7 years 8 months.

Results: Complete flap survival occurred in 93 percent of flaps. There was one partial and one total flap failure. The overall infection rate was 12 percent (n = 3). Two of these patients were treated successfully and one required partial calcanectomy. In all cases, solid bone union was achieved. However, 72 percent of the patients suffered from pain or degenerative changes.

Conclusions: Type IIIB open calcaneal fractures require systematic and meticulous treatment. Free tissue transfer is the essential component of providing healthy tissue for achieving adequate wound healing with reduced infection rates.

Taipei, Taiwan

From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University.

Received for publication January 15, 2005; accepted March 10, 2005.

Disclosure: No financial support or benefits have been received by any of the authors in the preparation of this article.

Chih-Hung Lin, M.D., Division of Trauma Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Kweishan, Taoyuan 333, Taiwan,

©2008American Society of Plastic Surgeons