Open fracture of the tibia and fibula Gustilo III B: Reconstruction using a medial hemisoleal flap.

Abstract

Abstract:

It is defined as a fracture exposed to communication between the outside and the continuity solution of a bone segment. This type of injury is more frequent in the hand, followed by those located in the leg, which represent 25%. Traffic accidents are the main etiology of this type of injury and, in the tibia and fibula, 50% of these injuries correspond to types IIIA and IIIB of the Gustilo classification.

Clinical case: 27-year-old male patient who presented crushing trauma to the left leg due to a metallic structure. He goes to the Enrique Garcés Hospital, being assessed by the traumatology deparment who classifies it as an open fracture of the tibia and fibula Gustilo IIIB, performs surgical cleaning and placement of external fixators. Subsequently, several sessions of surgical debridement were carried out until negative cultures were obtained and it was assessed by the plastic surgery deparment, planning coverage with a left medial hemisoleus muscle flap. Results: The coverage of the defect was achieved, preserving the plantar flexion of the foot, since only the medial belly of the soleus was used, the thin plantaris tendon and the gastrocnemius muscle, which contribute to the plantar flexion of the foot, were spared.

Conclusions: The present case shows that the medial hemisoleal flap is the technique of choice for the coverage of Gustilo III B open fractures of the tibia and fibula in the middle third of the leg