Journal of Musculoskeletal Trauma

Reconstruction of a Traumatic Soft Tissue Defect: Jong Woong Park; J Korean Fract Soc 2015;28(4):256-265. Published online October 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.4.256

Soft tissue defect combined with an open fracture is a very challenging problem to the orthopaedic surgeon. Many complicated open fractures remain with soft tissue defect, chronic osteomyelitis, and sometimes terminate with major limb amputation. Soft tissue defect should be reconstructed as soon as possible, particularly when the bone, tendon, or neurovascular structures are exposed. Exposure for longer than a week significantly increases the risk of secondary infection and tissue necrosis. For the simple soft tissue defect, negative pressure wound closure technology has been introduced and many superficial wounds have been treated successfully using this method. For the more complicated wounds, many kinds of local flaps, pedicled flaps, muscle and fascisocutaneous flaps can be indicated according to the characteristics of the wounds. The free flaps including free vascularized bone graft can be considered as a final choice for the most difficult wound problems. In this article, various reconstruction strategies for soft tissue defect after traumatic open fracture are reviewed.

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New proposal for skin grafts on tendon-exposed wounds
Jung Hwan Um, Dong In Jo, Soon Heum Kim
Archives of Plastic Surgery.2022; 49(01): 86. CrossRef
Soft Tissue Reconstruction for Open Tibia Fractures
Young-Woo Kim, Ho-Youn Park, Yoo-Joon Sur
Archives of Hand and Microsurgery.2020; 25(3): 207. CrossRef

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Treatment of Type IIIb Open Tibial Fractures: Seong Yeon Lim, Il Jae Lee, Jae Ho Joe, Hyung Keun Song; J Korean Fract Soc 2014;27(4):267-273. Published online October 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.4.267

Abstract PDF

PURPOSE
The purpose of this study is to evaluate the outcome of treatment for patients with Type IIIb open tibial fractures.
MATERIALS AND METHODS
This study targeted 35 adult patients for whom follow-up was possible over one year after undergoing surgical treatment. There were 29 males and six females with an average age of 45 years.
RESULTS
Fracture location was proximal in 10 cases, midshaft in 13 cases, and the distal part of the tibia in 12 cases. An average of 10 days was observed for definitive fixation with soft tissue coverage of the injury. The mean time to radiographic union was 27 weeks. Sixteen cases (45.7%) of complications were observed. Three cases of superficial infection, two cases of deep infection, four cases of partial flap necrosis, three cases of mal-alignment, three cases of joint stiffness, and one case of hardware breakage were observed. The mean lower extremity functional scale score was 68.5 and the factors influencing the clinical results were severity of open wound (p=0.000) and occurrence of complications (p=0.000) according to results of multiple regression analysis.
CONCLUSION
In treatment of Type IIIb open tibial fractures, good clinical results can be expected provided that complications are prevented through proper reduction, firm fixation, early soft tissue reconstruction, and early rehabilitation.

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Effect of Korean Medicine Treatments in Patients with Proximal Tibia Fracture: A Retrospective Observational Study
Jung Min Lee, Eun-Jung Lee
Journal of Korean Medicine Rehabilitation.2020; 30(3): 141. CrossRef

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Comparison of Treatment Outcomes of Infected Nonunion of the Tibia by Ilizarov Fixator according to Location of Nonunion and Reconstruction of Soft Tissue Defect: Soo Kyung Lee, Jung Ryul Kim, Jong Han Lim, Jun Mo Lee; J Korean Fract Soc 2010;23(1):57-63. Published online January 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.1.57

Abstract PDF: PURPOSE
To study clinical results and complications in the treatment of infected nonunion of the tibia according to location of nonunion and reconstruction for soft tissue defect.
MATERIALS AND METHODS
36 cases of tibia infected nonunion which were treated with the llizarov included in this study. There were proximal 1/3 in 14, middle 1/3 in 10, and distal 1/3 in 11 cases. Coverage of the soft tissue were treated with the free flap in 8 cases as classified group A and non-free flap in 17 cases classified group B. We evaluated the healing index, complications and comparing the results of each treatment by the Paley method.
RESULTS
Bone union was achieved in all cases. The proximal nonunion showed better results than those in the middle and distal area; average healing index: 35.6 days/cm (p=0.038), bone results: 92.9% (p=0.025), functional result: 90.5% (p=0.03). Group B showed significantly better results as it showed average healing index: 30.3 days/cm (p=0.015), bone results: 85.7% (p=0.025), functional results: 90.5% (p=0.015).
CONCLUSION
The nonunion of proximal 1/3 showed better results than other sites. Soft tissue reconstruction with free flap that control infection more effectively, could be improved the treatment outcomes.

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Staged Management of High Energy Proximal Tibia Fractures with Severe Soft Tissue Damage: Seung Ryul Lee, Jae Hoon Yang, June Kyu Lee, Hyun Dae Shin, Kyung Cheon Kim, Kyu Woong Yeon, Young Mo Kim; J Korean Fract Soc 2009;22(3):152-158. Published online July 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.3.152

Abstract PDF: PURPOSE
To find out the efficiency of two staged operation of patients with high energy proximal tibia fracture with severe soft tissue damage, the first step being external fixation, and the second, internal fixation with plates.
MATERIALS AND METHODS
The study group was the 42 patients who had followed for one year out of a group of 56, performed the first step external fixation and the second step internal fixation with plates retrospectively, from March 2003 to March 2007. The average age of the study group was 51.4, 26 men, and 16 women participating in this study. The average time of follow up was 32 months. In the final follow up, investigations of the radiological assessments and functional abilities of the bony fusion were carried out along with the complications of the soft tissue.
RESULTS
The duration after the first step external fixation until second step internal fixation to be performed was 14.9 (6~40) days in average. The final bone fusion took about 15 weeks, and according to the final follow up, the range of motion of the knee was around 110.8 degrees (6.2~117 degrees). In 31 cases, only the internal fixation was performed, while in 11 cases, soft tissue reconstruction was carried out with the internal fixations. As for the complications there were 2 cases of deep soft tissue infection, 2 cases of nonunion, 1 case of malunion and 1 case of knee joint stiffness.
CONCLUSION
In cases of proximal tibia fracture with severe soft tissue damage, external fixation was important to secure the safety of the fracture, carry forward the anatomical alignment, plan the soft tissue safety and manage the wound to decrease the number of microbial in the next operation, which is the internal fixation with plates.

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Anterolateral Thigh Island Flap: Jae Hoon Lee, Il Hoen Choi; J Korean Fract Soc 2008;21(3):207-212. Published online July 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.3.207

Abstract PDF: PURPOSE
To present the author's experience using the anterolateral thigh island flap for reconstruction of soft tissue defects around the hip and perineum.
MATERIALS AND METHODS
Proximal based anterolateral thigh island flaps were performed to reconstruct the soft tissue defects at the perineum (3 patients) and the greater trochanter of the hip (one patient) in 4 patients. All patients were male. Mean age was 43 years (range, 32 to 50 years) and mean follow-up was 8 months (range, 6 to 13 months). The causes of the defects were traffic accident in 2 cases, necrotizing fasciitis 1 case, and pressure sore 1 case. Average size of the flap was 14x9 cm. Fasciocutaneous flaps were performed in 3 patients and musculocutaneous flap was performed in one patient.
RESULTS
All flaps were survived. There were no necrosis of the flaps. One flap presented venous congestion after surgery, which resolved with the decompression of the pedicle. Reconstruction with the anterolateral thigh island flap resulted in no recurrence of the infection or ulcer and good esthetic contour.
CONCLUSION
The anterolateral thigh island flap is a reliable flap for reconstruction around the perineum and hip joint.

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Negative Pressure Wound Therapy for Traumatic Soft Tissue Defects: Keun Bae Lee, Jin Choi, Eun Sun Moon, Taek Rim Yoon, Keun Young Lim; J Korean Fract Soc 2006;19(1):67-71. Published online January 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.1.67

Abstract

PURPOSE
To evaluate the negative pressure wound therapy for traumatic soft tissue defects by vacuum-assised closure (V.A.C.(R)).
MATERIALS AND METHODS
33 patients with traumatic soft tissue defects were treated by using V.A.C.(R) which removes edema fluid, eliminates an extrinsic cause of microcirculatory embarrassment and may directly stimulate cellular proliferation of reparative granulation tissue. We removed all necrotic tissue prior to application of the V.A.C.(R). The foam dressing was placed into direct contact with wound and was changed every 48~72 hours. The setting for vacuum pump was continuous pressure of 100 to 125 mm Hg. C-reactive protein was checked to evaluate wound infection. We measured wound size and total duration of treatment.
RESULTS
Mean duration of treatment was 25.2 days and mean decrease of wound size was 31.9%. The concentration of CRP after V.A.C.(R) therapy reduced by day 8 below 1.0 mg/dl and gradually decreased to normal level by day 10. All patients showed hastened wound healing by rapid formation of granulation tissue.
CONCLUSION
Negative pressure wound therapy is useful in patients with traumatic soft tissue defects, which reduces treatment duration and cost by rapid wound healing and effective infection control.

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Negative-Pressure Wound Therapy Using Modified Vacuum-Assisted Closure in Patients with Diabetic Foot Ulcers
Bong Jae Kim, Ji Hye Suk, A Ra Jo, Jong Kun Ha, Chan Woo Jung, Seong Oh Park, Hyung Taek Park, Mi Kyung Kim
Journal of Korean Diabetes.2011; 12(2): 122. CrossRef
Acute Management of Soft Tissue Defect in Open Fracture
Ki-Chul Park
Journal of the Korean Fracture Society.2010; 23(1): 155. CrossRef

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Bone & Soft Tissue Injuries Diagnosed by Magnetic Resonance Imaging in Thoracolumbar Fractures: Yong Min Kim, Dong Soo Kim, Eui Seong Choi, Hyun Chul Shon, Kyoung Jin Park, Gi Seok Han, Jae Jung Jeong, Kyoung Il Jeong, Yung Sung Kim; J Korean Fract Soc 2004;17(2):184-190. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.184

Abstract PDF

PURPOSE
To assess diagnostic efficacy of the MRI in thoracolumbar fractures, especially in changes of bone and soft tissue which cannot be documented by other diagnostic tools.
MATERIALS AND METHODS
Among 85 patients managed for thoracolumbar fractures between January 1997 and June 2003, MRI was performed in 30 patients to get more informations. Plain X-ray, CT and MRI of these cases were reviewed retrospectively by two orthopaedic spine surgeons and one radiologist to investigate the informations which only MRI could afford.
RESULTS
14 (46.7%) among 30 patients had occult fractures of vertebrae other than main fracture which had not been diagnosed as fractured. Besides 6 patients who showed distraction of posterior structure on plain X-ray, injury of posterior ligament complex was confirmed by MRI in 12(40%) patients. Additionally, MRI visualized other soft tissue injuries such as intramuscular and subcutaneous hematoma, changes of the spinal cord and intervertebral disc. In 16 among 30 patients, informations achieved from MRI were the most important factors in deciding treatment modality.
CONCLUSION
MRI seems to be efficient in visualizing not only soft tissue injury such as ligament but also occult fractures of additional vertebra in thoracolumbar fractures, therefore MRI seems to be an important diagnostic tool in decision of treatment modalities, especially in cases of uncertain stability.

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Measurement Discrepancy of Sagittal Parameters between Plain Radiography and 3D Computed Tomography in Thoracolumbar and Lumbar Fractures
Dong-Soo Kim, Yong-Min Kim, Eui-Sung Choi, Hyun-Chul Shon, Kyoung-Jin Park, Byung-Ki Cho, Ji-Kang Park, Hyun-Cheol Lee
Journal of the Korean Orthopaedic Association.2012; 47(3): 198. CrossRef
Relationship between Lamina Fractures and Dural Tear in Low Lumbar Burst Fractures
Ki-Chan An, Dae Hyun Park, Yong-Wook Kwon
Journal of the Korean Fracture Society.2011; 24(3): 256. CrossRef

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AMRI Study of Associated Soft Tissue Injury in Tibial Plateau Fractures: Jang Suk Choi, Young Chang Kim, Sung Suk Seo, Ki Chan Ahn, Chang Sub Lee, Jae Sang Choi; J Korean Soc Fract 2000;13(3):501-506. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.501

Abstract PDF: Tibial plateau fractures can occur concomitent with injuries to the collateral, cruciate ligament and mensci. The purpose of this article is to demonstrate the frequency of soft tissue injuries associated with tibial plateau fractures and analyze the pattern of fracture more accurately by magnetic resonance imaging(MRI). Thirty one plateau fractures were evaluated in this study. MRI was more accurate in determining the classification of the fracture and measuring the displacement and depression of fragment. There was a 71%(22 of 31) frequency of associated soft tissue injuries in this series of tibial plateau fractures. The medial collateral ligaments were injured in 32.3%(10 of 31), the anterior cruciate ligaments in 29%(9 of 31), the posterior cruciated ligament in 22.5%(7 of 31), the lateral collateral ligament in 19.4%(6 of 31), and the menisci in 39%(12of 31). Schatzker type II and IV fracture patterns were associated with the highest frequency of soft tissure injuries. Medial collateral ligament injuries were most commonly associated with Schatzker type II fracture patterns. Menisci were most commonly injured with Schazker type IV fracture patterns. Most of the patients with acute tibial plateau fracture were commonly associated with ligamentous and meniscal injuries. MRI can aid in accurate evaluation of tibial plateau fracture patterns and decision of treatement plan.

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