Soft-tissue reconstruction of the leg associated with the use of the Hoffmann external fixator
Velazco, A.; Fleming, L.L.; Nahai, F.
Journal of Trauma 23(12): 1052-1057
1983
ISSN/ISBN: 0022-5282 PMID: 6655751 Document Number: 207797
Soft-tissue injuries and defects associated with severe tibial fractures treated with the Hoffmann external fixator were reviewed. Of 84 cases of open tibia fractures (classified as Gustilo's Type II and III), 54 patients with 55 injured limbs required soft-tissue reconstruction other than skin grafts or small rotational flaps. These 55 cases were constructed with 37 local musculocutaneous flaps (20 gastrocnemius, 17 soleus and other smaller muscle flaps), 15 free musculocutaneous flaps (14 latissimus dorsi and 1 tensor fascia lata) and 3 medial gastrocnemius cross leg flaps. In all cases the soft-tissue reconstruction was done with the external fixator in place. All but 3 of the musculocutaneous flaps healed with no problems (94%). Bony healing ws found in 30 cases (69.09%) at 18-mo. followup. There was 1 amputation after 2 failed local flaps and 3 late amputations due to patient's request (infected nonunion). There was a nonunion rate of 25.45% (14 cases) at 18 mo. postinjury. The Hoffmann external fixator allowed bony stabilization and did not preclude the subsequent soft-tissue reconstruction or bone grafting. Muscle and musculocutaneous flaps, local and free, were employed in the reconstruction of the leg with minmal interference from the Hoffmann device.