Concurrent internal fixation and soft tissue reconstruction by distally based sural flap: a practicable scheme for complex distal tibial fractures

Background It is difficult to establish both fracture union and wound healing of open fractures complicated with soft tissue defects of the distal tibia. We describe the simultaneous use of internal fixation and soft tissue coverage by a distally based sural flap (DBSF) for these complex injuries. Methods Seventeen patients with Gustilo IIIB open fractures of the distal tibia were operated on by internal fixation and DBSF coverage. Data were collected on the size of the defect, time to fixation and soft tissue coverage or 'fix & flap', types of implant, time to union, postoperative complications and objective clinical measurement. Results The average size of the soft tissue defect after debridement was 6.4 x 8.4 cm(2) (range 4.0-9.0 x 6.0-12.0). The mean time to fix & flap was 8.1 days (range 7-10). A medial precontoured plate was used in 8 patients and an anterolateral precontoured plate in 9. All fractures were united in a mean duration of 22.6 weeks (range 20-28). One patient had partial flap necrosis. Using the Puno functional score, 2 patients had excellent functional outcomes and 15 patients had good functional outcomes. Conclusion Concurrent Internal fixation and soft tissue reconstruction by DBSF is effective and reproducible for Gustilo type III open fractures of the distal tibia even in cases of more than 50 cm(2) soft tissue defects.