Management of Old Gustilo-Anderson Type IIIB Open Tibial Fractures With Medial Gastrocnemius or Combined Medial Gastrocnemius-Hemisoleus Flaps.

Abstract

Introduction  Old Gustilo-Anderson Type IIIB open tibial fractures presenting one to three months post-primary management with deep infection, superinfection, and inadequate soft tissue coverage pose significant treatment challenges. This study evaluates the outcomes of medial gastrocnemius or combined medial gastrocnemius-hemisoleus flaps in managing these old injuries, along with adjuvant orthopaedic (orthoplastic) procedures. Methods  A retrospective review was conducted on 15 cases involving fractures of the middle third of the tibia. These patients had initially undergone debridement and external fixation as primary management and presented one to three months post-injury. Management involved infection control through daily irrigation and debridement. In the definitive stage, revision of external fixation was performed along with decortication of the exposed tibia, bone grafting, and local muscle flap coverage.  Results  All fractures achieved union with complete infection eradication and durable soft tissue coverage, enabling full functional recovery with normal gait and strength. All patients returned to their pre-injury functional status and occupations.  Discussion Old Type IIIB fractures are underreported. This study highlights the role of staged infection control, decortication of the exposed tibia, bone grafting, revision of external fixation, and local muscle flap coverage in promoting bone healing, soft tissue restoration, and eradication of infection leading to satisfactory functional outcomes.