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Arch Hand Microsurg > Volume 23(3); 2018 > Article
Archives of Hand and Microsurgery 2018;23(3):206-216.
Published online September 1, 2018.
DOI: https://doi.org/10.12790/ahm.2018.23.3.206   
The Usefulness of Perforator Flaps for the Definitive Management of Exposed Hardware in Patients with Lower Extremity Fracture
Sue Min Kim1, Kwang Sik Jeong1, Hyung Keun Song2, Myong Chul Park1, Dong Ha Park1, Il Jae Lee1
1Department of Plastic & Reconstructive Surgery, Ajou University Hospital, Suwon, Korea. i00325@live.co.kr
2Department of Orthopaedic Surgery, Ajou University Hospital, Suwon, Korea.
Received: 15 May 2018   • Revised: 17 July 2018   • Accepted: 18 July 2018
Abstract
Purpose
Hardware exposure after the lower extremity fractures operation is challenging to manage and requires long-term treatment. The traditional management of exposed hardware usually includes hardware removal. The purpose of this study was to evaluate the proper treatment for the cases with exposed hardware in patients with lower extremity fracture.

Methods
Between October 2011 and October 2015, a total of 14 cases of hardware exposure who had previously been managed for lower extremity fractures required surgical debridement, revised surgery by the orthopedic surgical team and reconstruction with fasciocutaneous perforator flaps. A retrospective chart review was performed.

Results
Of the 14 cases included, 5 were open fractures at the time of the initial injury, and 9 were closed. The management of the exposed hardware was determined after examining the bony union status and device loosening. Anterolateral thigh free flap, posterior tibial artery perforator-based propeller flap, and peroneal artery perforator-based propeller flap were performed. All flaps survived without major complications. There were three cases of persistent infections that required the removal of the hardware again and repeated debridement. All three cases involved hardware that had been exchanged during the flap surgery because of loosening.

Conclusion
We achieved positive results by treating exposed hardware with fasciocutaneous perforator flaps and maintaining the original hardware, except in the cases where it had loosened. In cases with device loosening, there is possibility of progression to persistent infection and osteomyelitis even after properly treated with device exchange and soft tissue reconstruction.
Key Words: Lower extremity, Orthopedic fixation devices, Wounds and injuries, Perforator flap
 
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