A Case of Salvage by Anterior Tibial Artery Perforator Flap of an Infected Implant after Internal Fixation for Tibial Comminuted Fracture

Abstract

An implant that becomes infected or exposed after internal fixation must usually be removed. In some cases, a muscle flap can be used to salvage an implant, because of its soft tissue coverage and fresh vascularity. However, there are no reports of implant salvage using an anterior tibial artery perforator flap.
Here we describe a case of an amateur runner who suffered a tibial comminuted fracture in a traffic accident. Four weeks after undergoing internal fixation in a private hospital, the patient developed an infection around a locking plate. At the orthopedic surgeon's request, and after discussing the situation with the patient, we transferred a pedicled fasciocutaneous flap nourished by the anterior tibial artery onto the infected implant, after debridement and washing. This procedure successfully salvaged the implant.
There are only a few reports on factors that influence the successful salvage of an implant using muscle flaps, and no reports on those influencing salvage by a fasciocutaneous flap. Here we showed that an anterior tibial artery perforator flap is useful in some cases of lower leg reconstruction.