Abstract
Background Compound tibial fractures with extensive comminution and soft tissue defects are
limb-threatening reconstructive challenges. The purpose of this study was to assess
the long-term outcomes and the reliability of the latissimus dorsi scapula flap for
this indication.
Methods The hospital records of 26 compound tibial fracture patients treated with the latissimus
dorsi scapula flap were reviewed. An overall assessment was performed in several steps
based on a preinformation and two function-related questionnaires together with radiographs,
clinical overviews, and functional tests.
Results In 85% of the cases, the fractures had resulted from high-energy trauma and had extensive
zone of injury. The mean follow-up time was 6.2 years. Nine patients required reconstruction
because of prolonged sequelae after infection, nonunion, or tissue deficiency. One
flap loss occurred leading to amputation. Six patients required an additional operation
to enhance bony union. Full weight–bearing was allowed in 3 months and the mean time
to bony union was 10 months. Overall, 90% returned to their pretrauma occupation.
Overall 11 patients were lost to follow-up. A total of 14 patients answered the questionnaires
whereas 12 outpatients attended the clinical assessment. The main finding after evaluating
the results of the functional tests and reviewing the questionnaires was the limitation
in ankle movement while the donor site performed well.
Conclusion This study confirms that osteomuscular latissimus dorsi scapula flap reconstruction
is a suitable alternative for compound and comminuted tibia fractures especially in
the case of extensive soft tissue injury with bony loss or significant comminution
and with high probability of amputation.
Keywords
latissimus dorsi scapula flap - bone defect - compound tibial fracture
