Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2025; 13(28): 108710
Published online Oct 6, 2025. doi: 10.12998/wjcc.v13.i28.108710
Efficacy of free-flap-transfer and plate-fixation for Gustilo IIIB fractures in type II diabetic patients: A retrospective study
Qi Bao, Sun-Wen Pan, Xiao-Kang Gong, Bo Wang, Zhi-Nan Wei, Yong-Qing Xu, Yue-Liang Zhu, Zhen Shi
Qi Bao, Department of Plastic and Reconstructive Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Sun-Wen Pan, Department of Orthopedics, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Xiao-Kang Gong, Department of Orthopedics, Hangzhou Tianmushan Hospital, Hangzhou 310063, Zhejiang Province, China
Bo Wang, Department of Forensic Medicine, Hainan Medical University, Haikou 571199, Hainan Province, China
Zhi-Nan Wei, School of Medicine, Zhejiang University, Hangzhou 310030, Zhejiang Province, China
Yong-Qing Xu, Department of Orthopedics, 920th Hospital of Joint Logistics Support Force of PLA, Kunming 650032, Yunnan Province, China
Yue-Liang Zhu, Department of Orthopedics, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China;
Yue-Liang Zhu, State Key Laboratory of Transvascular Implantation Devices, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Zhen Shi, Department of Burn and Plastic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi’an 710038, Shaanxi Province, China
Co-first authors: Qi Bao and Sun-Wen Pan.
Co-corresponding authors: Yue-Liang Zhu and Zhen Shi.
Author contributions: Bao Q and Pan SW contributed equally to the research; Zhu YL contributed to conceptualization; Shi Z contributed to methodology, visualization; Wang B contributed to software, validation; Pan SW contributed to formal analysis, supervision; Gong XK contributed to investigation; Xu YQ contributed to resources; Bao Q and Wei ZN contributed to data curation; Bao Q contributed to writing—original draft preparation; all authors have read and agreed to the published version of the manuscript.
Institutional review board statement: This retrospective study was approved by the Medical Ethics Committee of the 920th Hospital of Joint Logistics Support Force of PLA (IRB No: IRB-920IEC/AF/61/2021-01.1).
Informed consent statement: Informed consent was obtained from all subjects involved in the study.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: Data are not publicly available but accessible upon reasonable request to the corresponding author with ethics approval and confidentiality agreements.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen Shi, MD, Assistant Professor, Department of Burn and Plastic Surgery, Tangdu Hospital, Fourth Military Medical University, No. 1 Xinsi Road, Xi’an 710038, Shaanxi Province, China. shizhenxy@yeah.net
Received: April 22, 2025
Revised: May 25, 2025
Accepted: July 8, 2025
Published online: October 6, 2025
Processing time: 108 Days and 5.3 Hours
Abstract
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.

Keywords: Free flap; Gustilo IIIB fractures; Plate fixation; Type II diabetes; Soft tissue defect

Core Tip: Employing free flap transfer with plate fixation for Gustilo IIIB fractures in patients with type II diabetes shows promise in achieving successful bone union and flap viability despite challenges such as infections and plate removal. Careful patient selection and precise indications are crucial for optimizing outcomes in fracture management for diabetic individuals.