Use of distally based random flap in the management of soft tissue defects in upper two thirds of leg.

OBJECTIVE: To assess the results of cases with complex wounds exposing tibia who were managed with distally based random flaps. METHODS: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and Dow University Hospital, Karachi and comprised data between February 2000 and March 2013of patients who had been admitted with a recent or prior history of trauma with a soft tissue defect in upper two-thirds of tibia and who had undergone coverage procedure using distal based flap. RESULTS: The mean age of the total 21 patients in the study was 29±9 years, and 20(95%)were male. Road traffic accident was the most common mechanism of injury in 13(62%). Tibia was exposed in all the 21(100%) cases requiring soft tissue coverage. There was associated fracture of tibia in 18(86%) patients. Mean flap length was 12±1.7 cm and width was 5.3 ±0.86 cm. Maximum size for the flap dissected was 15x7cm. Donor site was covered with split thickness skin graft in 19(90.5%) patients. Flap survival rate was 100%. Only 2(9.5%) patients developed partial flap necrosis. Clinical outcome was graded as good in 19(90.5%) patients and fair in 2(9.5%). Superficial infection was observed in 2(9.5%) patients. CONCLUSIONS: Distal based flap appeared to be an effective solution for the coverage of soft tissue defects in upper two-thirds of leg.