Experience with cutaneous, muscular and myocutaneous flaps in orthopedic problems

ABSTRACT

An evaluation of 44 patients of soft tissue defects mostly due to extensive musculo-skeletal trauma needing coverage by cutaneous or myocutaneous flaps is presented in this article. It also includes ten cases of non traumatic soft tissue defects needing flap treatment. The indications included 1. Post-traumatic soft tissue defects. 2. Non traumatic chronic osteomyelitis without soft tissue defects. 3. Congenital soft tissue and skin problems like constrictions and contractures. 4. Soft tissue defects created by excision of tumours in limb salvage surgery. Skin flaps were mostly done where defects were small, infection mild and in all cases of congenital problems. Muscle flaps were used in larger soft tissue defects, in Grade III open fractures, cases of chronic osteomyelitis and soft tissue defects in tumour surgery. Most of the muscle flaps were in the region of tibia fibula and foot. Skin flaps showed 80% and muscular flaps showed 90% success rate. The overall rate of control of infection was 85%. There were two complete and two partial failures in muscle flaps. There were three complete and four partial failures in cutaneous flaps. We recommend the use of cutaneous flaps for relatively smaller and infection free defects and muscular or musculocutancous flaps where the soft tissue defects are bigger and there is greater degree/risk of infection like grade III B open fractures