Delayed Reconstruction of the Perforator Pedicle Propeller Flap after the Induced Membrane Technique for Gustilo IIIB Open Distal Tibial Fracture

Objective This study aimed to evaluate the safety and efficacy of delayed reconstruction of the perforator pedicle propeller flap after the induced membrane technique in the treatment of Gustilo IIIB open distal tibial fracture, and to evaluate the clinical outcome and complications of two different perforator pedicle propeller flaps. Methods Thirty-four patients with Gustilo IIIB open distal tibial fractures treated by the induced membrane technique and delayed reconstruction of two different perforator pedicle propeller flaps from May 2017 to March 2022 were retrospectively analyzed. Patients were divided into two groups according to the different kinds of perforator pedicle propeller flaps covered. The operation required two stages. The Radiographic Union Score for Tibial fractures (RUST) was used to evaluate the healing of the tibial bone defect. The American Orthopaedic Foot and Ankle Society (AOFAS) score was used to evaluate ankle function. The complications associated with the technique were recorded. Results The number of serial debridements, excluding those performed during emergency and final operations, was a mean of 2.28 +/- 0.83 in the PAPF group and 2.19 +/- 0.83 in the PTAPF group. The PAPF group had a mean bone defect length of 6.76 +/- 0.69 cm, the median healing time of 13.11 +/- 0.96 months, RUST score 12.68 +/- 1.63, and AOFAS score of 84.12 +/- 6.38. On the other hand the PTAPF group's mean bone defect length was 6.73 +/- 0.95 cm, the median healing time 12.63 +/- 1.46 months, RUST score 13.73 +/- 1.53 and AOFAS score 82.79 +/- 5.49. There were no observed significant differences between the two groups in the number of serial debridements, bone defect length, bone union time, RUST score, or AOFAS score (p > 0.05). Flap size ranged from 9 x 6 cm(2) to 14 x 7 cm(2) in the PAPF group and from 9 x 6 cm(2) to 13 x 7 cm(2) in the PTAPF group. There were no severe complications such as flap-related complications or amputation. The differences in complications in the two groups were not statistically significant. Conclusion In cases of severe open tibial fracture, the reconstructive method is important. When delayed reconstruction is inevitable, surgeons should first perform radical debridement, followed by vacuum sealing drainage as a bridging therapy; both PAPF and PTAPF can be considered for definitive soft tissue coverage.