Efficacy of free-flap-transfer and plate-fixation for Gustilo IIIB fractures in type II diabetic patients: A retrospective study.

[BACKGROUND] Managing Gustilo type IIIB fractures in patients with type 2 diabetes is challenging due to delayed healing and elevated complication risks. This retrospective study highlights the successful use of free-flap transfer combined with plate fixation, contributing insights into effective management strategies for these complex cases.

[AIM] To evaluate free-flap transfer with plate fixation for managing Gustilo IIIB fractures in diabetic patients, focusing on outcomes.

[METHODS] A retrospective analysis of six cases was conducted with a minimum follow-up period of three years. Patients underwent free-flap transfer and plate fixation for fracture management. Outcomes assessed included bone union, flap viability, and complications requiring intervention or plate removal. The follow-up period ranged from three to four years. Persistent infections beneath the flap developed in two patients, necessitating daily wound care.

[RESULTS] Bone healing occurred within 17 to 34 months, with plate removal required in three patients after fracture consolidation. Traumatic osteomyelitis was observed in at least one patient. Despite challenges such as sinus formation and variations in flap pedicle anatomy, successful bone union and flap viability were achieved in all cases. Free-flap transfer combined with plate fixation shows promise for treating Gustilo type IIIB fractures in patients with diabetes. While infection and the need for plate removal surgeries were observed, consistent success in bone healing and flap viability highlights the potential of this approach.

[CONCLUSION] Free-flap transfer with plate fixation effectively manages Gustilo IIIB fractures in diabetics, achieving bone/flap healing despite infection risks. Careful patient selection and further validation are critical.