Outcome Comparison between Free Muscle and Free Fasciocutaneous Flaps for Reconstruction of Distal Third and Ankle Traumatic Open Tibial Fractures

摘要

Our residents tell us, "muscle is best" for covering open tibial fractures. We have done a thorough job indoctrinating our trainees with this concept despite minimal direct clinical evidence. Basic science studies emphasize the rich blood supply of muscle and its ability to deliver antibiotics and immunologic cells to the fracture site.1 However, clinical studies have also shown successful extremity reconstruction using fasciocutaneous flaps,2 which have a rich fascial plexus.3 In addition, inflammation can dramatically increase vascularity; we have all experienced incising a flap years after Y inset and observing a more robust blood supply than when the flap was originally inset. Ideally, prospective clinical trials are needed to determine whether muscle flaps truly are superior to fasciocutaneous flaps