Muscle Transposition for Repair of Skin Defects Over Exposed Bone / 대한정형외과학회잡지

ABSTRACT

The management of chronic skin defect over the pretibial region, sacral pressure sore and other bony protuberant area is extremely difficult due to the presence of necrotic and infected bone, avascular and infected scar tissue, dead space and anatomical sparse of available adjacent structure. The present methods of management include versatile varieties and have left much to be revised, but they often despaired of both surgeon and patient, especially due to persistent chronic osteomyelitis and recurrent ulcer. From January, 1975 to April, 1979, we have had treated 20 such cases with application of muscle flap transposition and following has been observed. 1. The cause of lesion were 11 cases of the traffic accident, 4 cases of the industrial accident, 2 cases of the falling from a height, 2 cases of the pressure sore and 1 case of the chronic osteomyelitis. And 15 cases of them were physically active young adult between 2nd decade to 4th decade. 2. The muscles used for pretibial lesion were medial head of gastrocnemius m., soieus m., flexor digitorum longus m. and peroneus brevis m. Used abductor hallucis m. for medial malleolar defect, gluteus maximus m. for sacral pressure sores and sartorius m. for exposed knee joint. 3. There existed hematoma formation in 2 cases, partial necrosis of transposed muscle in 3 cases and persistent infected sinuses in 3 cases. Other cases except the last 3 cases, which needed another surgical procedure and antibiotic therapy, were controlled without difficulty and all of them did not develope any recurrence of ulcer during the follow up duration. 4. There did not appear to be any significant long term functional residua due to loss of original function of the transposed muscle except somewhat unacceptable cosmetic result. 5. It was 2 months average for the healing cases which did not need a bone graft and 5 months average for the cases needed a bone graft.