The Flaps That Orthopaedic Surgeons Need to Know: Practical Flaps/Pedicle Reconstruction in Compound Limb Injuries
Abstract
Govindbhai Jashvantlal Purohit and Yogesh Purohit
Background: Compound limb injuries frequently involve extensive soft tissue loss with exposed bone, joints, or implants. Timely vascularized soft tissue coverage is critical for preventing infection, non-union, and amputation. Although microsurgical free tissue transfer has significantly improved limb salvage rates (1,5,6), such facilities are not universally available. ORTHOPLASTIC integration allows orthopaedic surgeons to perform reliable soft tissue reconstruction in resource-limited settings.
Objectives: To evaluate the effectiveness, safety, limb salvage rate, and functional outcomes of fasciocutaneous and pedicled flap reconstruction performed by an orthopaedic surgeon.
Methods: A retrospective observational study was conducted on 134 patients treated over 38 years (1986–2024). Seventeen cases treated with isolated skin grafting were excluded, leaving 117 patients requiring advanced reconstructive procedures. Techniques included fasciocutaneous flaps, cross-leg flaps, abdominal and thigh pedicled flaps, reverse sural flaps (4), and local rotational flaps. Outcomes were assessed using flap survival, complication rates, fracture union, limb salvage, and Lower Extremity Functional Scale (LEFS).
Results: Patients ranged from 15–78 years (mean 35.5 years). Trauma was the predominant etiology. Overall flap survival exceeded 95%. Minor complications occurred in three cases (4.5%) and were successfully managed. Limb salvage was achieved in all major reconstructive cases. In selected tibial fractures with residual gaps of 1.5–2 cm, spontaneous bone formation (neo-osteogenesis) was observed following flap coverage, likely due to improved local vascularity.
Conclusion: Fasciocutaneous and pedicled flaps performed by trained orthopaedic surgeons provide reliable, cost- effective, and reproducible soft tissue coverage. In appropriately selected cases, these techniques offer outcomes comparable to more complex reconstructions (2,7,8).