Tibial cortex transverse transport for long-term chronic wounds after serious lower limb trauma / 中华创伤骨科杂志

ABSTRACT

Objective:To explore the effects of tibial cortex transverse transport for long-term chronic wounds after serious lower limb trauma.Methods:From January 2016 to July 2021, 11 patients with long-term chronic wounds after lower limb trauma were treated at Department of Orthopedic Surgery, 920 Hospital of Joint Logistics Support Force of PLA. They were 7 males and 4 females, aged from 19 to 57 years (average, 32.3 years). There were 7 lesions of the popliteal artery and 4 ones of the anterior and posterior tibial arteries. The wound was located at the distal leg in 5 cases and at the foot and ankle in 6 ones. The wound size ranged from 3.2 cm × 2.8 cm to 9.5 cm × 7.3 cm. An external fixator for transverse transport was installed after the cortical bone fenestration was performed on the medial tibia more than 10 cm away from the wound surface, with a fenestration area of 5.0 cm × 1.8 cm. The wound was limitedly debrided, irrigated thoroughly and bandaged. Transverse transport began on the postoperative day 7, with the wounds opened for care and dressing change. The transverse transport lasted 25 days and the external fixators were dismantled 2 months after surgery. The healing of the wounds and incisions for transverse transport was observed.Results:The 11 patients were followed up for 3 to 20 months (average, 5.6 months). The wounds healed after 35 to 277 days. By the last follow-up, all the wounds healed without recurrence. Incision infection occurred in 2 patients, whose transverse transport was continued and wounds healed after local debridement; another patient suffered from poor incision healing, which responded gradually to decreased speed of transverse transport.Conclusion:Tibial cortex transverse transport can significantly improve the local blood supply and promote granulation and healing of long-term chronic wounds after serious trauma at the lower leg, foot and ankle.