A PROSPECTIVE RESEARCH ON THE FASCIO-CUTANEOUS FLAPS ROLE AS AN INTERVENTION OF THE COVERAGE OF SOFT TISSUE IN (TYPE 111 – B) OPEN TIBIAL FRACTURES

Object: The determination of the fascio-cutaneous flap role as the coverage of the soft tissue in open tibial fractures of type 111 – B as experienced by the professor of Mayo Hospital, Lahore. Material and Methods: Sample of this prospective research was of forty-one patients having tibia fractures of (type 111 – B). Every case was treated in the orthopedic surgery and traumatology department from September 2015 to September 2017. We did not include the patients diagnosed with peripheral vascular disease and diabetes mellitus. After antibiotic cover and resuscitation debridement was carried out followed by the application of back slab. Next day of the treatment again debridement was carried out and stabilization was also carried out with the help of external fixator. Wound became clean by numerous debridement's, it was now ready for flap subsequently covered with the fascio-cutaneous flap. After five days the dressing was replaced and at the interval of two weeks removal of stitching was carried out. The basic data of the patients was assessed regarding injury site, fascio-cutaneous flap type, complications and acceptance. Results: The average age of the patients was observed as (31.8 years), as per the injury site 7 cases (16.66%) of proximal tibia were sustained, 12 cases of middle tibia (28.57%), 17 cases of distal tibia (40.47%), 4 cases of middle 2/3rd (9.52%) and 2 cases of distal 2/3rd (4.76%) tibia. Executed flaps pattern were based on the proximal medial flaps in 4 cases (9.52%), 3 cases were of proximal based lateral (7.14%), 8 cases were of distal based medial (19%), 17 cases of distal based lateral (40.47%), 2 cases of cross leg (4.76%), 2 cases of sural flap (4.76%), 4 cases of distal lateral retrograde (9.52%), 2 cases of random pattern flaps (4.76%) and 2 cases of soleus muscle flaps (4.76%). In the total of 42 cases 33 cases were good (78.57%), 6 cases were fair (14.28%) and 3 cases were poor (7.14%). Observed complications were as 6 cases of marginal necrosis (14.28%), 3 cases of complete or partial necrosis (7.14%), 3 cases of superficial infection (14.28%) and 5 cases of deep infection (11.9%). Conclusion: Our research concludes that fascio-cutaneous flap is a procedure which is safe, simple and cost effective along with (type 111 – B) good acceptance of the open tibial fractures. Key Words: Type (111 – B) open tibial fractures, fascio-cutaneous flaps and soft tissue coverage.