Long-term functional outcome of limb-salvage in Gustilo-type ⅢB and ⅢC open fractures of the tibia / 中华骨科杂志

ABSTRACT

Objective To evaluate the long-term func ti onal outcome of the Gustilo-typeⅢB andⅢC open fractures of the tibia treate d with limb-salvage.Methods Twenty-onepatients,including16cases of Gustil o-tapeⅢB and5cases of ⅢC open fractures of the tibia,were repaired by30f ree vascularized tis-sue flap transfer from1990to1999.The soft tissue and bone defect of 13cases Gustilo-typeⅢB open frac-tures of the tibia wer e repaired simultaneously with osseous-cutaneous flap or musculo-cutaneous-o sseous flap transplantation,the soft tissue defect in3cases of open fractures of the tibia were covered with cutaneous flap or musculo-cu taneous flap at first setting,and the tibia defect or non-union were repaired with vascu lari zed osseous flap at the second.The posterior tibia vessels were reconstructed in all of 5cases of Gustilo-typeⅢC group,in3cases of which posterior tib ial nerve were repaired simultaneously,and emergency cutaneous flap or musculo-cutaneous flap transfer were performed in2cases,delayed vascularized flap tr ansplantation were performed in another3cases.The salvageable limb function w as assessed according to the punos sev en-scale score criteria which includin g freedom of pain,activities of daily life,range of motion,residual deform ity,ra-diographic changes,muscle strength and sensation.Results Twnety-twov ascularized tissue flaps were trans-ferred at first setting in21patients,1 9vascularized tissue flap survived,and other3vascularized tis sue flap failed .The survival rate was86.4%.The average duration from the injury to the f irst vascu larized tis sue flap transplatation was84days.The soft tissue defe ct was completely re paired after the second setting and the fracture or defect was united finally;the average number of procedure for the Gustilo-typeⅢB was4and10for the Gustilo-typeⅢC tibial fractures with an average period fr om injury to bony union of 210and640days in typeⅢB and typeⅢC respective ly.After an average58months of follow-up,ranging from17to129months, 10case obtained excellent and good re sults(62.5%),4cases fair(25 .0%),2cases poor (12.5%)in Gustilo-typeⅢB tibia open fracture.Th ere were no one with excellent,good and fair results,5cases poor (100%) in Gustilo-typeⅢC.Conclusion Theamputation below the knee should be consid-e red for the Gustilo-typeⅢC open fractures of the tibia,especially along wit h the severe injury of the ankle or the dis ruption of poste rior tibial ner ve or the obvious limb shortening.The Gustilo-typeⅢB open frac-tures of t he tibia should deserve reconstruction with the technique of microsurgery,and the functional recov-ery of the salvageable limb was satisfactory.