ABSTRACT
BACKGROUND: Membrane induction technique for treating long bone defects has advantages of few complications, significant treatment efficacy and ease in operation. In previous studies, membrane induction technique was used to treat bone defect patients with good cartilage tissue, but there are few reports regarding bone defects with large area of cartilage tissue defect or accompanying infection. OBJECTIVE: To analyze the efficacy of flap transplantation combined with membrane induction technique for repairing long bone defects and soft tissue defects. METHODS: Fifteen patients with long bone defects and soft tissue defects who were treated in Affiliated Nanhua Hospital, University of South China from October 2016 to August 2018 were selected. They were aged (47.15±8.16) years. The soft tissue defect area was 5.1 cm x 3.4 cm-21.8 cm x 9.4 cm. The length of bone defect was 5.8-19.5 cm, with an average of (11.4±2.3) cm. The patients with mildly polluted wounds underwent debridement, external fixation of fracture, and filling bone cement in the bone defect area. Wounds were covered with local pedicle flaps or free flaps. Wound infection patients underwent vacuum sealing drainage, bone cement filling and flap surgery after infection was controlled. The second graft surgery was performed at 8 to 12 weeks after primary intention, and patients were followed up for 12 months. This study was approved by the Institutional Ethics Committee of Affiliated Nanhua Hospital, University of South China. RESULTS AND CONCLUSION: (1) Nine patients with mildly contaminated wounds were treated with external fixation after debridement, bone cement filling and flap transposition. No infection occurred. (2) Six patients with infection were treated with vacuum sealing drainage for 1 to 2 weeks. After the infection was controlled completely, bone cement filling and flap transplantation were conducted. All wounds were healed. (3) Fifteen patients achieved bone healing after second bone grafting. The healing time was between 8 and 12 months, with an average of (9.18±2.10) months. (4) These results suggest that skin flap transplantation combined with membrane induction technique can effectively treat patients with long bone defects and soft tissue defects.
ABSTRACT
Objective To summarize the nursing methods of Orthofix limb reconstruction system in the treatment of limb long bone defects. Methods Thirty-two patients with long bone defects were collected between January 2012 to January 2015. The patients were all treated with the Orthofix limb reconstruction system and perioperative nursing. Results All the cases were treated by the method for 8 . 5 to 18 . 2 months , averaged 15 . 40 ± 3 . 20 months . The bones extended 4 ~ 21 cm , averaged ( 8 . 06 ± 3 . 06 ) cm . The assessments of bone transport treatment showed 31 cases were excellent and 1 good. Conclusions The limb long bone defects with or without soft tissue defects caused by various causes can be treated by the Orthofix limb reconstruction system. Patients should pay attention to psychological counseling and nutritional support preoperatively. It is important for patients to pay attention to bone transport and functional exercise guidance postoperatively.
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 probe the pathogenesis of long bone defects and damage to epiphysis as the result of postoperative infections following fractures in the childhood of patients, and to look for ideal ways to prevent and repair the defects and damages. Methods The treatment of the infected bone defect of a tibia had been continued for one year following fracture in one four-year old patient, and the treatment of the infected bone defect of a humerus had been continued for ten years following fracture in another seven-year old patient, but all the treatments had failed. The injured limbs developed bone infection, bone defect, bone exposure, shortening, and pseudoarthrosis deformities at last. Then the lesions were completely cleaned, and the deformities of the infected bones were corrected in one stage, with reconstruction of the bone and the repair of the wounds by transplantations of fibular free flaps. Results Both fibular free flaps survived in one stage transplantation. The bones of the injured limbs healed half a year after the operations, and weight-bearing and walking functions of the injured limbs recovered as well. Conclusion Transplantation of fibular free flap was an ideal way to treat a long bone defect as a result of postoperative infection following fracture in the childhood. The early appropriate treatment of postoperative infection following fracture is very important to avoid bone and epiphysis damages.