A 40-year-old man sustains a full-thickness skin loss over the anterior tibia following a motorcycle injury. The tibial bone is exposed without periosteum. According to the reconstructive ladder, the most appropriate reconstruction is:
- A Free tissue transfer (free flap — e.g., free fibula or anterolateral thigh flap) ✓
- B Split-thickness skin graft
- C Secondary healing with dressings
- D Local rotational flap (fasciocutaneous)
Correct answer: A. Free tissue transfer (free flap — e.g., free fibula or anterolateral thigh flap)
Explanation
Exposed bare bone without periosteum will not support a skin graft or heal by secondary intention. Free tissue transfer is required to bring vascularised tissue over the exposed bone, providing both cover and blood supply to allow bone healing. The anterolateral thigh (ALT) or latissimus dorsi free flap is commonly used; muscle flaps also help combat infection in contaminated wounds.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.