Medial Gastrocnemius Muscle Flap as treatment for coverage of extensive tibial bone exposure associated to post-operative osteosynthesis infection: Case report and review of literature

Post-osteosynthesis infections are a common problem most surgeons and orthopedic surgeons deal with on a daily basis, it gets complicated when they affect certain specific body regions or bones, one of the most described is the one affecting the tibial bone and its exposure, for this affection ,many treatments are initial options but when all fail ,the best is to perform a gastrocnemius muscle flap due to its low failure rates and distant proximally based blood supply that allows these flaps to rotate up to 15 cm above the level of the knee, perfect for proximal tibial defects that both cover the defect and do not limit mobility of the patient. We describe the case of a 52 year old female, who had a proximal tibia fracture of her left leg and an internal fixator osteosynthesis was performed for proper alignment, two months after surgery she presented with surgical site infection near osteosynthesis material incisions, bone and osteosynthesis material were exposed ,causing necrotic tissue and purulent fluid formation. Patient had osteosynthesis material removed in first intervention and an extensive surgical debridement, where a 10cm x 8cm tibial bone exposure was presented. Patient was treated with broad spectrum antibiotics and negative pressure therapy the following 5 months due to E.Coli BLEE present in tissue cultures. Upon negative tissue cultures ,it was decided to perform a medial gastrocnemius muscle flap with split thickness skin graft to cover the exposed tibial cutaneous defect. Postoperative outcome was satisfactory, with a 90% integration and no post-op infections were associated.