Eur J Plast Surg (2004) 27:222 DOI 10.1007/s00238-004-0658-2 IN VI TED C OMMENTARY S. O. P. Hofer Commentary on “Reconstruction of an extensive tibial soft tissue defect with multiple local muscle flaps for limb salvage when free tissue transfer was not an option”, by Thornton and Pu Published online: 19 August 2004 Springer-Verlag 2004 The authors describe two cases of extensive soft-tissue I do not think that either patient in this report was unfit defects of the tibia in which they felt microsurgical re- for free flap transposition, since skin grafts and local construction was not an option. In their report they show muscle flaps in challenging cases need postoperative care that multiple local muscle transpositions can give nice similar to that for free flaps. The title is therefore a little results. The authors have to be commended on their ap- misleading and should rather have been “when free tissue proach, since they present applications of well-known transfer was not favorable”. In my experience, quite a few muscle flaps that are certainly worthwhile but may easily trauma patients are either not fully cooperative or have be overlooked nowadays. I would like to make a few com- psychiatric histories, but we still perform free flaps with a ments with regard to their approach and to the cases very high survival rate. presented. In conclusion, I believe this report is definitely worth- The ideal treatment of open tibial fractures is coverage while, to remind us of less-apparent options for difficult within the first 5 days of trauma after necessary de- challenges in coverage of lower-extremity cover. bridements . In that early phase, I would be reluctant to perform a lot of local muscle transpositions in a trauma- tized leg. However, in those cases where defects are References secondary, as shown in the current report, local transpo- 1. A report by the British Orthopaedic Association/British Asso- sitions can definitely be a good option. ciation of Plastic Surgeons Working Party on the management In the current report only a short follow-up is pre- of open tibial fractures. September 1997 (1997). Br J Plast Surg sented. In my experience, local flaps, even though they do 50:570–583 not break down, do fibrose somewhat distally, and will give chronic wounds or recurrent wounds in quite a few patients after periods longer than 1 year. S. O. P. Hofer ( ) Department of Plastic Surgery, Erasmus University, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands e-mail: email@example.com
European Journal of Plastic Surgery – Springer Journals
Published: Oct 1, 2004
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