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[Application of flap or musculocutaneous flap primary transplantation in Pilon fractures of type III].

OBJECTIVE
To discuss the value of one stage flap or musculocutaneous flap to repair the soft tissue defect in Pilon fracture.


METHODS
Twelve cases with Pilon fracture included 9 male and 3 female with an average age of 39.2 years ranging from 21 to 61 years. All fractures were type III according to Rüedi and Allgöwer. According to Gustilo sysytem, III a were in 4 cases, III b were in 8. A thorough debridement was made before internal fixation. After the internal fixation implanted, the tourniquet was released and a thorough debridement was made again. Be sure of the wound cleansed of all dead and foreign material, the wound was covered with local flap, musculocutaneous or gastrocnemius flaps depending on the size and localization of wound.


RESULTS
All the patients were followed up from 6 to 36 months, 18 months in average. The function of ankle was assessed according Mazur system. The results were excellent in 6 cases, good in 3, fair in 2 and poor in 1. No infection or necrosis happened on flaps. Although necrosis happened in the wound margin of two patients, they all healled up by conservative methods.


CONCLUSION
Primary closure of soft tissue defect in Pilon fracture using flap or musculocutaneous flap have ability to shorten the treating time and recover the function of ankle. It is important to have a thorough debridement of the dead tissue and free bone.