Bone, Tendon, and Soft Tissue Reconstruction in One Stage With the Composite Tensor Fascia Lata Flap

Abstract

A 46-year-old patient sustained a dia-infracondylar tibial fracture after a ski accident. Open reduction and internal fixation (ORIF) was carried out. After an initially uneventful postoperative course the patient was readmitted because of local and systemic infection signs. Radical surgical debridement was carried out following by Vacuum-Assisted Closure (VAC) therapy. The resulting defect consisted of bone defect of the tibia tuberosity, and complete loss of the patellar tendon and the overlying soft tissue. Reconstruction was carried out with a combined tensor fascia lata (TFL) flap including the TFL muscle with the ilio-tibial tract, vascularized part of the iliac crest and the overlying soft tissue. Bone healing took place without signs of osteomyelitis recurrence, and full weight bearing was possible 4 months after reconstruction. Successful reconstruction of the patellar tendon using the ilio-tibial tract, enables the patient full active knee joint motion. The soft tissue coverage shows stable conditions. The donor site showed inconspicuous healing without pain and normal range of motion of the hip joint. So this composite TFL flap is an interesting flap not only for defects following trauma, but also for combined defects following extensive infections after knee implants.

The use of negative pressure wound therapy for fracture-related infections following internal osteosynthesis of the extremity: A systematic review

“…The studies comprised seven case reports 19 , 20 , 21 , 22 , 23 , 24 , 25 and three case series. 17 , 26 , 27 Patient ages ranged from 12 to 83 years ( Table 1 ).…”

“…One study included fractures of the upper extremity, 17 and eight focused on lower leg fractures. 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 One study did not specify the anatomical region but included solely shaft fractures. 27 The ten studies had a total of 201 patients.…”

“… 24 2011 Case report 24 4 1 NPWT after reconstructive surgery, no osteosynthesis Windhofer et al. 25 2009 Case report 46 1 1 None excluded a The study group had an age range of 12–61 years. Only three patients met the inclusion criteria, but the age of these patients were not described.…”

“… 24 Skin graft 108 days Infected wound defect with visible implant Not described Windhofer et al. 25 Tensor fascia lata flap 2 months Purulence throughout fistula, local and systemic infections signs 29 days a Total days/months and range. …”

“… 24 NPWT, activated protein C 125 mmHg Intermittent, 5 min on, 2 min off 3 months and 18 days Not described Windhofer et al. 25 Debridement, NPWT, antibiotics Not described Not described 4 days Not described …”