ROLE OF FASCIOCUTANEOUS FLAPS AS A METHOD OF SOFT TISSSUE COVERAGE IN TYPE 111 – B OPEN TIBIAL FRACTURES

Object: To determine the role of fasciocutaneous flap as soft tissue coverage in type 111 – B open tibia fractures. An experience by orthopaedic surgeons at LUMHS Jamshoro. Material and Methods: This prospective study was containing 41 patients with type 111 – B fracture of tibia. All cases were managed in department of orthopaedic surgery and traumatology LUMHS Jamshoro from 2008 – 2012. Patients with diabetes mellitus and peripheral vascular disease were excluded from study. After resuscitation and antibiotic cover debridement done and back slab applied. On next day after routine investigations debridement was done and fracture was stabilized with external fixator. After multiple debridements as wound became clean and ready for flap, it is covered with appropriate fasciocuaneous flap. Dressing changed after 5 days and stitches removed after 2 weeks. Patients were assessed for their basic data, site of injury, type of fasciocutaneous flap ,their acceptance and complications. Results: Average age was 31.8 years, According to site of injury 7 (16.66%) cases sustained in proximal tibia, 12 (28.57%) in middle tibia, 17 (40.47%) in distal tibia, 4 (9.52%) in middle 2/3 rd of tibia and 2 (4.76%) in distal 2/3 rd of tiba. The pattern of executed flaps were proximal based medial flaps in 4(9.52), proximal based lateral in 3 (7.14%), distal based medial in 8 (19%), distal based lateral in 17 (40.47%), cross leg in 2 (4.76%), sural flap in 2 (4.76%), distal lateral retrograde in 4 (9.52%), random pattern flaps in 2 (4.76%) and soleus muscle flaps in 2 (4.76%) cases. Out of 42 cases 33 (78.57%) were good, 6 (14.28%) fair and 3 (7.14%) poor. Complications noted were marginal necrosis in 6 (14.28%), partial or complete necrosis in 3 (7.14%), superficial infection in 3 (14.28%) and deep infection in 5 (11.9%) cases. Conclusion: It is concluded that fasciocutaneous flap is a simple, safe and cost effective procedure with good acceptance in type 111 – B open tibial fractures