Treatment of widespread traumatic soft tissue defects of anterior tibia with free latissimus dorsi muscle-skin flaps using the medial sural artery as the recipient artery

Objective To explore the results of the treatment of widespread traumatic soft tissue defects of anterior tibia with free latissimus dorsi muscle-skin flaps using the medial sural artery as the recipient artery. Methods Eleven patients with widespread traumatic soft tissue defects of anterior tibia in the leg from April 2011 to February 2014 in our hospital were retrospectively analyzed. The patients were treated with the free flaps (latissimus dorsi muscle-skin flap) using the medial sural artery as the recipient artery. There were 8 males and 3 females, with an average age of (34.1 ± 5.2) years (range, 23~45 years). The tibia bone exposed lengths were about 1/2 to 2/3 of the length of the tibia, and the sizes of the defect area ranged from 15 cm×8 cm to 34 cm × 11 cm. In the operation, the medial sural artery was taken as the recipient blood vessel, and the venae comitans and great saphenous vein as regurgitation of the flap, which is the Anastomosis of blood vessel pedicle with free latissimus dorsi muscle-skin flap. The donor defect was closed directly or resurfaced with mid-thickness skin. Results ALL the eleven flaps survived at last. One case encountered operative revision due to postoperative thrombosis of phlebo-vessels, and then survived completely. The mean follow-up period was (14.7 ± 3.2) months (range, 11~18 months). The appearance, texture, color and thickness of flaps in all cases were good at the last follow-up, and all the flaps achieved protective sensation. No limitation occurred to the function of the joint of knee and ankle. No abnormality of upper limb activity in the donor area was left. Conclusions For patients with defect of widespread traumatic skin and soft tissue of anterior tibia , especially when only one major blood vessel was left, application of the medial sural artery anastomosis of free latissimus dorsi muscle-skin flap to repair the wound is an effective treatment method. Key words: Sural nerve/BS/SU; Surgical flaps; Muscle, skeletal/SU; Soft tissue injuries/SU