Comparative Study of Muscle and Fascio-cutaneous Flaps for Coverage of Exposed Tibia


  • Bhawna Prabhakar
  • Sanjay Sadhu
  • Apoorva Pratap Singh



muscle flaps, perforator flaps, propeller flaps, exposed tibia, free flaps


Background- Trauma is a leading cause of tibial fractures. In salvageable lower limb trauma, morbidity
can be greatly reduced with early soft tissue coverage of exposed tibia. Muscle flaps have traditionally
been preferred over fascio-cutaneous flaps for coverage. With better description of the vascular supply
of the lower limb, however, there is now a shift towards fascio-cutaneous flaps: pedicled or free soft
tissue transfer.
Methods- 216 patients who underwent flap coverage for exposed tibia in our institute between January
2015 and December 2020 were evaluated in this retrospective, comparative study. Parameters studied
were surgical complications, such as partial or complete flap necrosis, minor wound complications,
venous congestion, donor-site complications; development of wound infection and osteomyelitis;
duration of hospital stay; functional outcome and final aesthetic outcome
Conclusion- Fascio-cutaneous flaps were found superior to muscle flaps for coverage of exposed tibia
in many respects especially for middle and lower third defects. For upper third of tibia, gastrocnemius
muscle and musculocutaneous flaps provide adequate coverage. But in case of middle and lower thirds,
adequate coverage can be provided by perforator-based, propeller or distal sural flaps. If adequate
donor vessels are available, micro-vascular free soft tissue transfer, should be the preferred choice for
large defects.

Author Biographies

Bhawna Prabhakar

Assistant Professor, Department of Plastic and Reconstructive Surgery, SGRRIHMS and SMI Hospital, Dehradun

Sanjay Sadhu

Associate Professor, Department of Plastic and Reconstructive Surgery, SGRRIHMS
and SMI Hospital, Dehradun

Apoorva Pratap Singh

Academic Senior Resident, Department of Burns and Plastic Surgery, All India
Institute of Medical Sciuences, Jodhpur