A 72-year-old male, hypertensive and type 2 diabetic, with no other relevant history except for being a former smoker of 1 pack of cigarettes a day for 15 years.
She suffered a type III B fracture of the Gustilo Classification and distal third of the right tibia as a result of a traffic accident.
It is treated jointly by the Traumatology and Plastic Surgery Services on the same day of the accident by placing an external fixator and covering the defect that measured 4 x 5 cm, without difficulty with a distal saphenous flap.
The subsequent evolution is satisfactory until 2 months later, the patient presents with a fistulous tract at the distal end of the flap, with scarce secretion, without fever or other signs of infection.
Cultures taken were negative.
Since the fistula did not resolve, 1 month later (at 3 months after initial surgery), we decided to perform surgical revision of the fracture focus along with traumatology, performing flap lifting and envascularisation.
During the intervention, bone samples were taken for culture that was negative.
At that time, flap replacement did not allow closure of a tension-free wound, because we decided to dissect the cutaneous-subfascial tissue according to its anatomical components.
The adipofascial component was then represented as a fascial flap over the original defect, and the cutaneous-subcutaneous component was used as a second conventional random skin flap, which was created to cover the new distally rotated defect.
We covered the adipofascial flap originated from the dissection of the internal saphenous fasciocutaneous flap with a 4 x 5 cm partial skin graft taken from the ipsilateral thigh.
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The patient was discharged without complications one week after the second surgery, starting walking without load and walking with load two months later.
Follow-up was 18 months, with no complications.
