Generally, local propeller flap has an advantage in lower extremity reconstruction due to rich vascular perforator in lower extremity, short operation time and minimal donor site morbidity if compared to free flap. In this study, even though they were reconstructed with delayed period, we proved the statistical superiority of local propeller flap in the view of ICU days and operation time. This result was possible due to a smaller soft tissue defect in the antetibial area which was statistically meaningful if compared to the free flap group. Also, this study demonstrates that local propeller flaps result in a statistical significant lower inflammatory rate until postoperative day 3 compared to the free flap group. But local propeller flap has its limitations due to transfer of tissue from zone of injury, requirement of small defect size and the confirmation of perforator on radiologic assessment. These limitations can be surmounted with an ALT flap. An ALT free flap is described with healthy tissue transfer, long pedicle length, large skin territory, flow-though and chimeric concept design, a two-team approach, and no need for changing the position (Yildirim et al., 2003, Wyber et al., 1990). In our conclusion, local propeller flap can be a superior choice than free flap for patients whose zone of injury is localized to the defect site with small size in mid-proximal tibia area and underlying medical disease which makes patients vulnerable for a long operation. In contrast, the cases with big trauma vector which makes defect size larger with extensive zone of injury on distal tibia are better to be covered with free flap. With more patients’ data, we would expect to produce a critical indication in wound coverage between free flap and local propeller flap for open tibia fracture Gustilo type IIIb.
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22 - 국문요약 -
Comparison of delayed soft tissue coverage between anterolateral thigh free flap and local propeller flap on traumatic open tibial
fracture Gustilo-Anderson grade IIIb
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작고, 경비골 근위 부위의 결손일수록, 또한 외상의 정도가 크고 환자의 기저 질 환이 많아 긴 수술 시간 및 수술 후 염증 상태를 견디기 힘든 상황일수록 국소 프로펠러 피판술이 재건을 위한 좋은 선택으로 보여진다.
Key words :Free Tissue Flaps; Perforater Flap; Fractures, Open/surgery; Tibial Fractures/surgery; Reconstructive Surgical Procedures/methods