Free Composite Serratus Anterior-Latissimus-Rib Flaps for Acute One-Stage Reconstruction of Gustilo IIIB Tibia Fractures
TAKE-HOME POINTS
- Gustilo IIIB injuries with segmental bone loss can be difficult to treat with conventional means.
- Vascularized bone grafts are beneficial for reconstructing bone defects >5 cm.
- The SALR composite flap consists of bone and muscle.
- This flap can provide soft tissue coverage and vascularized bone in a single surgical procedure.
- In this study, the use of the SALR composite flap was capable of healing large segmental bony defects at an average of 7 months.
There are several limitations to this study. The small sample size and retrospective nature of the study limits the amount of data we are able to collect from the medical record and places obvious constraints on the analysis. Although all these procedures were performed at 1 institution, multiple providers were involved in the reconstruction of these injuries, and there is no standard protocol for their treatment. Similarly, although other forms of extremity reconstruction were used during this time period, there was no standard protocol that could serve as a comparator for patients who underwent an SALR compared with other reconstructive procedures.
Overall, SALR grafts provide an excellent option for 1-stage reconstruction of severe, open lower extremity injuries. In this series we noted a 100% graft success rate with an acceptable complication profile.
This paper will be judged for the Resident Writer’s Award.
