Tissue transplantation combined with Ilizarov distraction technique to reconstruct bone and soft tissue defects in lower limb / 中华显微外科杂志

ABSTRACT

Objective:To investigate the therapeutic effect of tissue transplantation combined with Ilizarov distraction technique in reconstruction of lower limb anatomical structure and the recovery of lower limb functions.Methods:From October, 2010 to April, 2019, tissue transplantation combined with Ilizarov distraction technique was used to reconstruct the anatomical structures and functions of 51 lower limb defects, including 17 in proximal tibia, 27 in distal tibia, 4 partial defects of calcaneus and 3 in metatarsal bones. Surgical operations were carried out in 2 phases. Transplantation of free flaps to cover the wound surface was performed in the first phase. Thirty-three free anterolateral femoral flaps, 8 groin flaps, 5 anterolateral medial femoral flaps, 3 thoracic umbilical flaps, and 2 alissimus dorsi musculocutaneous flaps were transplanted, with the sizes ranged from 3.5 cm×15.0 cm to 8.0 cm×25.0 cm. In the second phase, Ilizarov ring rack or customer-designed distractor were applied/employed and 44 cases applied with Ilizarov ring racks and 7 cases with self-designed distractors. Regular postoperative followed-up.Results:All flaps survived. There was 1 partial necrosis on the anterolateral femoral flap and 3 postoperative infections. Bone transport was applied to repair 36 tibia defects, bone transport combined with limb extension to restore the length of limb in 8 cases, bone transverse or longitudinal distraction was applied to restore the shape of calcaneus in 4 cases, and longitudinal or transverse distraction was applied to restore the foot arch in 3 cases with metatarsal defects. Followed-up for 9 months to 2 years. There was no recurrence of osteomyelitis after the second operation. Bone healings were achieved in the articulation ends and extension areas of bone transport. The excellent rate of Paley bone score was 98.0%, the average SF-36 score was 88.9, and the average AOFAS score was 79.5.Conclusion:Tissue transplantation together with the Ilizarov technology is able to reconstruct a combined bone and soft tissue defect of lower limb and restore functions of the affected limb to the greatest extent.