Treatment of infected tibial nonunion plus soft tissue defects with an Ilizarov external fixator combined with pedicle flap transfer / 中华创伤骨科杂志

ABSTRACT

Objective:To investigate the clinical effects of Ilizarov external fixation combined pedicle flap transfer in the treatment of infected tibial nonunion plus soft tissue defects.Methods:A retrospective study was performed to analyze the data of 35 patients with infected tibial nonunion plus soft tissue defects who had been admitted to Department of Orthopedic Trauma, Tianjin Hospital Affiliated to Tianjin University from July 2005 to July 2020. There were 25 males and 10 females with an age of (37.5±6.0) years. Their original traumas were 27 open and 8 closed fractures, with a disease course ranging from 8 to 42 months. Three patients had undergone 1 operation, 7 patients 2 operations, and 25 patients 3 or more operations. All patients presented with different degrees of skin and soft tissue defects or bone exposure, wound sinus formation and bone scaring. The size of pedicle flaps transferred ranged from 6 cm×5 cm to 15 cm×10 cm. Surgical transfer of skin flap and external fixation were performed at one stage in 25 patients while staged surgery was performed in 10 patients. The first stage consisted of local debridement, vacuum sealing drainage, and delayed flap operation while the second stage consisted of delayed flap transfer and Ilizarov external fixation. The survival of skin flap, limb shortening, bony union and complications were observed after operation. The limb function was evaluated according to the criteria of The Association for the Study and Application of Methods of Ilizarov (ASAMI) for bone and functional results.Results:All patients were followed up for (23.8±7.4) months. Fracture union was achieved in all. The flaps survived postoperatively, the wounds were repaired by the first intention, infection did not recur, and bony union was achieved in 32 patients. Partial necrosis of the flap edge occurred in 3 cases, but responded to dressing change. In the 10 patients undergoing delayed flap operation, 100% of the flaps survived. In all patients, the limbs were shortened by (0.8±0.1) cm, and the tibial fractures got united after (7.2±1.2) months. By the ASAMI criteria for bone results, 29 cases were excellent and 6 cases good; by the ASAMI criteria for functional results, 25 cases were excellent, 8 cases good, and 2 cases fair.Conclusion:As Ilizarov external fixation combined pedicle flap transfer can repair bone and soft-tissue defects at the same time, this surgical scheme facilitates infection control and leads to reliable outcomes.