Outcomes of free anterolateral thigh perforator flaps versus free modified latissimus dorsi myocutaneous flaps for Gustilo type IIIB open tibial fractures with necrosis and infection.

Background: Infection and non-union of fractures are potential complications of Gustilo type IIIB open tibial fractures. It is important to choose the most effective type of flap to reduce the incidence of infection and non-union.

Method: This study reviewed outcomes of 44 patients (aged 16-65 years) who underwent reconstruction of Gustilo type IIIB tibial fractures from January 2004 to January 2017. Patients received a free anterolateral thigh perforator flap (ALTP; n = 23) or modified latissimus dorsi myocutaneous flap (MLD; n = 21). Demographic data, intraoperative data, postoperative complications, and long-term outcomes were compared between groups.

Results: Flap complications occurred in 8 patients (18.2%) after flap reconstruction: 6 in the ALTP group and 2 in the MLD group ( < 0.05). No patient developed total flap necrosis. Rates of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) normalization were higher in the MLD group than in the ALTP group at 2 and 4 weeks after flap transfer ( < 0.05). By 6 months, fracture union occurred in 52.4% of patients in the MLD group and 30.4% of those in ALTP group ( < 0.05). By 9 months, union occurred in 85.7% of MLD group patients and 52.2% of MLD group patients ( < 0.05).

Conclusion: MLD was associated with fewer flap complications, shorter time to ESR and CRP normalization, and higher union rates by 6 and 9 months, compared with ALTP. These results suggest that MLD may provide a better environment for reducing susceptibility to infection and promoting fracture healing in Gustilo type IIIB tibial fractures with necrosis and infection.