{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T20:18:38Z","timestamp":1788898718384,"version":"build-2803163510"},"reference-count":34,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,9,30]],"date-time":"2023-09-30T00:00:00Z","timestamp":1696032000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chosun University"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Introduction: Distal tibial fractures make up approximately 3% to 10% of all tibial fractures or about 1% of lower extremity fractures. MIPO is an appropriate procedure and method to achieve stable metal plate fixation and osseointegration by minimizing soft tissue damage and vascular integrity at the fracture site. MIPO to the medial tibia during distal tibial fractures induces skin irritation due to the thickness of the metal plate, which causes discomfort and pain on the medial side of the distal leg, and if severe, complications such as infection and skin defect may occur. The reverse sural flap is a well-researched approach for covering defects in the lower third of the leg, ankle, and foot. Materials and Methods: Among 151 patients with distal tibia fractures who underwent minimally invasive metal plate fixation, soft tissue was injured due to postoperative complications. We treated 13 cases with necrosis and exposed metal plates by retrograde nasogastric artery flap surgery. For these patients, we collected obligatory patient records, radiological data, and wound photographs of the treatment results and complications of reconstructive surgery. Results: In all the cases, flap survival was confirmed at the final outpatient follow-up. The exposed area of the metal plate was well coated, and there was no plate failure due to complete necrosis. Three out of four women complained of aesthetic dissatisfaction because the volume of the tunnel through which the skin mirror passed and the skin plate itself were thick. In two cases, defatting was performed to reduce the thickness of the plate while removing the metal plate. Conclusions: Metal plate exposure after distal tibial fractures have been treated with minimally invasive metal plate fusion and can be successfully treated with retrograde nasogastric artery flaps, and several surgical techniques are used during flap surgery.<\/jats:p>","DOI":"10.3390\/medicina59101751","type":"journal-article","created":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T16:58:09Z","timestamp":1696179489000},"page":"1751","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Treatment of Soft Tissue Defects after Minimally Invasive Plate Osteosynthesis in Fractures of the Distal Tibia: Clinical Results after Reverse Sural Artery Flap"],"prefix":"10.3390","volume":"59","author":[{"given":"Jun Young","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, College of Medicine, Chosun University, 365 Pilmundae-ro, Dong-gu, Gwangju 61453, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyo Jun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, College of Medicine, Chosun University, 365 Pilmundae-ro, Dong-gu, Gwangju 61453, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Hoon","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, College of Medicine, Chosun University, 365 Pilmundae-ro, Dong-gu, Gwangju 61453, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Je Hong","family":"Ryu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, College of Medicine, Chosun University, 365 Pilmundae-ro, Dong-gu, Gwangju 61453, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyoung Tae","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, College of Medicine, Chosun University, 365 Pilmundae-ro, Dong-gu, Gwangju 61453, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung Ho","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Daejung Hospital, 180 Daein-ro, Dong-gu, Gwangju 61473, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Hwan","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170 Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ho Sung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170 Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Koo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170 Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1302\/2058-5241.2.150047","article-title":"Intra-articular fractures of the distal tibia: Current concepts of management","volume":"2","author":"Sitnik","year":"2017","journal-title":"EFORT Open Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"57","DOI":"10.5704\/MOJ.2011.010","article-title":"Surgical management of distal tibia fracture: Towards an outcome-based treatment algorithm","volume":"14","author":"Rushdi","year":"2020","journal-title":"Malays. 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