gms | German Medical Science

Objectives/Interrogation: To investigate the clinical therapy of early internal fixation combined with free flaps for Gustilo type IIIB forearm open fractures.

Methods: A retrospective study was conducted of the 15 patients with Gustilo type IIIB forearm open fracture who had been treated from July 2014 to July 2017 at our department. They were 10 men and 5 women, aged from 22 to 68 years (average, 45.5 years). AO classification: type A 4 cases, type B 9 cases, type C 2 cases. Primary internal fixation and second-stage perforator flaps transfer 11 cases, second-stage internal fixation and flaps transfer 4 cases,all the 15 patients received free flap transplantion, site of the defect: 4 cm×8 cm~8 cm×33 cm. The period between injury to second-stage flap transplantion was 4~28 days (average, 10.2 days). There were all anterolateral thigh perforator flaps.

Results and Conclusions: All the 15 cases of free flaps were survived with no deep infection and osteomyelitis. 4 cases had suoerficial infection at wound. Partial necrosis happened at the distal end of 2 cases and healed with skin grafts. 1 anterolateral thigh perforator flap encountered vascular complication which survived with 3 cm-in-width skin necrosis at the distal end of the flap after successful surgical exploration. All the patients were follow-up for 12~36 months (average, 18.5 months). All the flap texture was soft, with varying degrees of pigmentation. The sensory recovery of flap was S2 in 2 cases, S3 in 10 cases, S4 in 3 cases. Bone union time ranged from 4 to 14 months (average, 8.6 months), 2 cases of nonunion were treated with autologous iliac bone grafting 8 months after operation. The curative effect was evaluated by Anderson standard: 10 cases were excellent, 3 cases good, 1 cases better and 1 cases poor. Conclusion It is a effective strategy to treat the Gustilo type IIIB forearm open fractures with soft tissue defects by early internal fixation combined with free flaps transfer, which has advantages of shorten the treatment period, recovering exercise early, decrease complications, and satisfactory function.