L Herzog, FX Huber, PJ Meeder, G Muhr
Division of Trauma and Plastic Surgery, Department of Surgery, Heidelberg University, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany

J Buchholz
Surgical Hospital Wermelskirchen, Koenigstr. 100, 42929 Wermelskirchen, Germany

PURPOSE. Open lower leg fractures are frequently associated with severe soft tissue damage, followed by osteomyelitis. Using an animal experimental model, we investigated the effect of timing of coverage of a tibial fracture with a local muscle flap.

METHODS. 80 rabbits had a tibial fracture induced in a standardised fashion, which was stabilised by screw osteosynthesis. After 3 (group A; n=40) and 7 days (group B; n=40), respectively, the tissue defect was covered by a local gastrocnemius flap. In increasing intervals from 1 to 2, 4, 8, and 16 weeks, the rabbits from each group were killed and the bone fracture was analysed histomorphologically. Cortical microcirculation was measured by 2-channel laser doppler flowmetry.

RESULTS. Muscle flaps after 3 days improved perfusion significantly as compared with 7 days (24 Flux [standard error, 5 Flux] versus 10 Flux [3 Flux]; baseline, 1.4 Flux). Group A animals also displayed a lower rate of necrosis (0 versus 38). The incidence of osteomyelitis was higher in group B than in group A (24% versus 0%).

CONCLUSION. Laser doppler flowmetry was proven to be a reliable, minimally invasive means for identifying avital tissue, leading to reduction in the loss of vital bone tissue in experimental settings.

Key words: decortication; laser doppler flow; local muscle flap; open fracture