Introduction
Open Mid-tibial fracture wound reconstruction is a challenge and traditionally required large muscle flaps even for relatively smaller defects. These lead to added morbidity, limb weakness and excessive scar burden and cosmetically poor results.
We present a case series of “segmental” Longitudinally Split Tibialis Anterior Muscle(TA) flap as a simple, reliable, local option for smaller defects.
Methodology and Operative technique
Six consecutive cases with open Tibial injuries from June 2018 to June 2023 (5 years) were included in this study where the soft tissue defect is 5cm or smaller which needed soft tissue reconstruction. Segmental tibial fractures were excluded.
After fracture fixation, Incision was extended 2-3cm proximally and distally to demonstrate the TA muscle segment adjacent to the defect and was dissected off from the bone with the periosteum. Several muscular perforator vessels from Anterior Tibial neurovascular bundle were identified under 3.5X loupe magnification during flap dissection. On the deep periosteal surface, a longitudinal split of the muscle fibers were performed up to the tendon which was then split open to create a flat tendon. This unfolded muscle was then advanced over the exposed tibia as a flap and inserted to the periosteum followed by a skin graft. Limited transverse division of proximal muscle fibers was done to increase the flap advancement.
These patients were prospectively followed-up for flap viability, dehiscence, graft loss, infections and the dorsiflexion power of inverted foot. Mean follow-up was 14 weeks postoperatively.
Results
Age of patients ranged from 17 to 45 years and Male: Female is 2:1. There were no flap or graft losses. Wounds healed well with minimal scar related problems. In all patients, grade 3/5 or above dorsiflexion power was observed.
Discussion / Conclusion
Segmental longitudinal split TA flap is a Functional, reliable and versatile flap specially when the tissue defect is smaller.