Use of radial forearm flaps to treat complications of closed pilon fractures

Abstract

Between 1986 and 1990, five patients have been treated for full-thickness skin loss proximal to the level of the anterior joint line of the ankle following open reduction and internal fixation of closed C3 (ASIF) pilon fractures. The average delay from injury to the initial open reduction and internal fixation was 4.6 days. Anteromedial and posterolateral incisions were used to expose the fractures, resulting in a bipedicle flap over the anterior aspect of the ankle joint at the time of the initial surgery. The minimum distance between these two incisions for these five patients was 6.0 to 9.0 cm (average of 7.4 cm). Free tissue transfers using the radial forearm flap were effective in providing durable but thin coverage for this difficult problem of soft-tissue coverage in an area requiring a thin flap with a long vascular pedicle. The risk for skin necrosis at the time of surgery may be minimized by spacing the incisions up to 12.0 cm apart in addition to avoiding the period of maximal tissue ischemia occurring 3 to 6 days after the injury.