The musculocutaneous sural artery flap for soft-tissue coverage after calcaneal fracture.

Soft-tissue defects following calcaneal fractures can be covered in a relatively easy and safe procedure. We have modified the familiar distally based sural artery flap by lifting a part of the gastrocnemius muscle. With an inferior pedicle, this musulocutaneous flap can be rotated onto the defect on the sole of the foot and on the heel. Five patients with open fractures of the calcaneus or wound necrosis after osteosynthesis were treated with this procedure. Two defects were covered uneventfully, two flaps were prepared, the rotation being done in a secondary procedure. One patient demanded further revisions, and the flap was partially lost, but the remaining defect was covered after open treatment. This new musculocutaneous sural artery flap can be used for covering even an extensive defect after calcaneal fractures and seems to be a reliable procedure. Morbidity at the donor site is low, and in the case of failure, the free flap remains an alternative.

[The determinants of the quality of life after a type-III open tibial fracture. The results of a multicenter study]. / Determinanten der Lebensqualität nach offenem Unterschenkelbruch Typ III. Ergebnisse einer Multicenterstudie.

This study investigated to what extent quality of life four years or more after the fracture is determined by initial staging (Gustilo subclassification, time from injury to arrival at hospital), by the therapeutic course (length of hospital stay, number of operations), by complications (amputation, infection) and by demographic factors (gender, age). A total of 197 patients after type III open tibial shaft fractures (type IIIA 70, type IIIB 85, type IIIC 42) from nine centers volunteered to participate in this study. During patients' follow-up appointments (mean duration of follow-up 50 months), therapeutic course, pre-surgical staging and demographic data were recorded by the surgeon. Patients were asked to rate quality of life on the Nottingham Health Profile and on a visual analogue scale. Multiple regression analysis (stepwise) identified two predictors for reducing overall quality of life (F-test: P = 0.007): number of operations (adjusted beta: -0.21) and age (adjusted beta: -0.17). Other factors showed no significant relationship with overall quality of life or with subscales of the Nottingham Health Profile. These findings indicate a dilemma between two therapeutic goals: good functional outcome, which often requires repeated operations, and quality of life, which suffers under prolonged surgical treatment.