ABSTRACT
Objective To discuss the technique and clinical effect of infective long bone defect treated by external fixator combination of iliac bone graft with deep iliac circumflex vessels.Methods All 28 patients with posttraumatic infective long bone defect were treated by external fixator and iliac bone graft with deep iliac circumflex vessels from July, 2008 to June, 2014.The length of the bone defect was from 3 to 7 cm (averaged 5.1 cm), including tibia defect in 13 patients, femoral defect in 7, humeral defect in 4, and ulna and radius defect respectively in 2, and 17 patients also with soft tissue defect.After thorough debridement, the bone defect was fixed by the external fixator, and then VSD was applied for irrigation drainage.As fresh granulation tissue growth, iliac bone vascularized by deep iliac circumflex vessels, size from size 5.0 cm× 3.0 cm to 8.0 cm× 3.5 cm, was transplanted.As for composite defect of infective bone and soft tissue in 17 patients, 6 cases of them was repaired with the iliac flap combined free flap, three with the iliac flap combined local skin flap, 4 cases with the iliac flap doubled with both the deep and the shallow iliac circumflex vessels, 3 cases with the circumflex iliac artery chimeric perforators flap and 1 with random iliac osteocutaneous flap.Affected limb function was graded with Enneking's system.Results All transplanted vascularized iliac bone survived, postoperative infection controlled well, but there were 2 patients of iliac flap partial necrosis.After dressing exchange and reoperation, the wound all repaired again.Twenty-six patients followed from 8 to 50 months, with an average of 18 months while 2 patients lost postoperative.The osseous healing time of the iliac bone graft was an average of 6.5 months, 25 patients healed well but 1 case encouraged tibia fracture again.Appearance of the limb also recovered satisfactorily.Twenty-six patients had the average limb function restored in 89.7％.There was no obvious complication in the donor.Conclusion It is an effective technical method to treat infective long bone defect by external fixator combination of iliac bone graft with deep iliac circumflex vessels, which can not only fix and bridge bone defects and enhance bone healing, but also obliterate dead space and resist local infection by ensuring blood supply.But the method is suitable for the receipt site infection under control and the length of the long bone defect less than 10 cm.
ABSTRACT
Objective To explore the surgical method and curative effect of free vascularized fibular graft bridged vascu?lar pedicle by vein transplantation for infective long bone defect with or without soft tissue defect reconstruction. Methods From June 2008 to January 2014, 17 patients with infective long bone defect were treated, 11 male and 6 female, 1.5 to 55 years old and averaged 31.3 years. 8 cases in femur, 5 cases in tibia, 3 cases in humerus and 1 case in radius. Bone defect were 4 to 19 cm in length with an average of 9.4 cm. 8 cases with soft tissue defect, from 5.0 cm×3.0 cm to 17.0 cm×5.5 cm. Required adequate surgi?cal debridement, and vacuum sealing drainage (VSD) was used. Free vascularized fibular (skin) flap was designed and harvested . Artery and veins close to the health site were dissected, and bridged vascular pedicle of free vascularized fibular flap by autolo?gous vein transplantation with end to end anastomosis. The length free vascularized fibular graft was from 5 to 18 cm, with an aver?age of 9.6 cm. The free fibula flap ranged from 6.5 cm×4.0 cm to 18.0 cm×6.0 cm. Results All the 17 cases of fibular flap sur?vived, no vascular crisis happened. Post?operative wound primary healed in 11 cases, delayed 1 to 2 weeks to heal in 6 cases. Cal?lus was seen in the 6 to 8 weeks later. 15 cases were followed from 9 months to 6 years (averaged 30 months) while 2 cases were lost to follow?up. Bone defect primary healed in 13 cases, and the fibula graft unhealed in 2 cases, but healed again after a second operation. Fibula stress fracture occurred in one case at 7 months after grafting procedures and bone union was achieved 4 months after reapplying an external fixator. Infected bone defect healing time ranged from 4.2 to 9.8 months, averaged 5.9 months. Accord?ing to the Enneking score, 11 cases were excellent, good in 3 cases, one in fair. Excellent and Good rate was 93.3%. Conclusion Free vascularized fibular (skin) graft with vein bridged vascular pedicle can not only effectively repair infected bone and soft tissue defect, but also improve local blood supply and control infection, shorten the course of treatment, which is an effective treatment of infective long bone defects with or without soft tissue defects.