Title: Management of Soft Tissue Complications of the Lateral Approach for Calcaneal Fractures
Authors: Pedro C. Cavadas, MD., Ph.D., Luis Landin, MD
Source: Journal of Plastic and Reconstructive Surgery, 120; August 2007;459-466
PODIATRIC RELEVANCE:
Open reduction internal fixation has become the standard of treatment for intra articular calcaneal fractures . However, wound healing complications, such as infection and skin necrosis remain relatively frequent, and its consequences dramatic, due to the restricted amount of soft tissue coverage and precarious vascularity.
METHODS:
In this article, 24 patients who had developed skin necrosis with exposed hardware, secondary to lateral approach for open reduction internal fixation of intra articular calcaneal fractures, were treated using an experimental algorithm. Skin flaps were selected and patients were then followed up between 5 and 52 months. The wounds were classified as infected if purulent discharge was noted, or non-infected. In the infected wounds, treatment was based on the quality of anatomical reconstruction. In three cases, the hardware was not removed, and the wound was closed using an ipsilateral segmental free distal vastus lateralis flap and PMMA beads (with gentamycin and vancomycin) and the dorsalis pedis artery and greater saphenous vein as recipient vessels. In the other case, the hardware was removed and a sural flap was used, along with PMMA beads. The non-infected wounds were classified as minor (<1.5cm), moderate (1.5cm to 5cm wide), or extensive (>5cm or concomitant plantar skin loss). The schematic of the algorithm is included in the article.
RESULTS:
All the free flaps were successful; there were two cases of distal necrosis in sural flaps for moderate-sized defects. Both cases were successfully salvaged using a free vastus lateralis flap. No chronic infections developed.
COMMENTS:
The study population was only of 24 patients all of which were worker’s compensation patients, which are known for poorer outcomes and therefore not a realistic representation of the general population to which a universal algorithm can be applied. Sixty percent of the patients in this study were able to return to work. The authors however, related this outcome more to the sequelae of the skeletal reconstruction.
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Disclaimer:
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