skin cover

Basic Concepts

Proximal tibia

- gastrocnemius local muscle flap

- gracilis free muscle flap if gastroc damaged

Middle tibia

- soleus local muscle flap

- gracilis free muscle flap

Distal tibia

- posterior tibial fasciocutaneous local flap

- gracilis free muscle flap

Management Principles

Stage the infection, the host & the management 

1.  Stage host / maximise healing potential

2.  Stage infection / MCS / sensitivities

3.  Debride all infected bone and ST

4.  Stabilise skeleton

5.  Eliminate dead space

6.  Soft tissue coverage