Management of soft-tissue complications of the lateral approach for calcaneal fractures.

摘要

BACKGROUND: Soft-tissue complications after using the lateral approach for internal fixation of calcaneal fractures are relatively frequent, even in skilled hands. The global management of these wounds has never been standardized. METHODS: The authors present a series of 24 patients with wound edge necrosis of lateral approaches for displaced intra-articular calcaneal fractures. Follow-up ranged from 5 to 52 months. The wound was covered with a local subcutaneous transverse flap in six cases, a sural subcutaneous flap in 12 cases, and a distal vastus lateralis free flap in six cases. Hardware was removed only if gross malalignment of the fracture was present. A treatment algorithm is proposed. RESULTS: All the transverse local flaps were successful. Two sural flaps had complications that were salvaged with a free flap. All free flaps were successful, and all fractures healed. No chronic infections developed. CONCLUSIONS: The authors' algorithm proved useful. For minor necroses (<1.5 cm wide) with supple tissues and no infection, the transverse local subcutaneous flap was effective. For moderate-sized wounds (1.5 to 5 cm) with no infection, a sural subcutaneous flap was used. In infected wounds with good fracture reconstruction, a free flap was used without hardware removal. If unsatisfactory bone reconstruction and infection were present, hardware removal and a sural flap were appropriate. For extensive defects (>5 cm) or when regional flaps failed, a free flap was useful.