Artificial Deformity Creation as a Method for Limb Salvage for Patients with Massive Tibial and Soft Tissue Defects: A Report of 26 Cases.

Soft tissue and bone defects that occur consequence of high-energy trauma are serious and challenging problems. The aim of this retrospective cohort study is to show that the artificial deformity creation (ADCr) method allows the closure of soft-tissue defects, avoids amputation, and can facilitate the reconstruction of bone defects and restore limb length. Patients and methods: Twenty-six adult patients (age range 20-81 years) with soft tissue defects of the lower limb were treated at the Riga East University Hospital from 2018 to 2021. All patients were treated using the ADCr method which is the technique of establishing an interim deformity for resolving tissue loss. The lower extremity functional scale (LEFS) and application of methods of ilizarov (ASAMI) criteria were used for the evaluation of bone healing and lower extremity function. Results: Complete union was achieved in all cases. The functional evaluation showed that most patients could achieve excellent and good results and return to activities of daily living. The functional result was poor in one case of a multi-fragmentary distal tibial articular fracture for which an ankle fusion was performed. Final union in this case was achieved with some residual deformity. Conclusion: The method of ADCr is an effective surgical technique in cases of severe tibial injuries with concomitant loss of bone and soft tissues. This method could be used in cases when either a plastic or microsurgeon is not available or for instances when closing the defect with a flap is either impossible or contraindicated. Excellent and good functional results are possible without severe complications. How to cite this article: Plotnikovs K, Kamenska J, Movcans J, et al. Artificial Deformity Creation as a Method for Limb Salvage for Patients with Massive Tibial and Soft Tissue Defects: A Report of 26 Cases. Strategies Trauma Limb Reconstr 2023;18(3):133-139.

Acute Shortening for Open Tibial Fractures with Bone and Soft Tissue Defects: Systematic Review of Literature.

Introduction: The presence of massive soft tissue loss in open tibial fractures is a challenging problem. Acute limb shortening is an alternative solution in situations where the use of flaps is limited. Materials and methods: A review was conducted following the Preferred Reported Items for Systematic Reviews and Meta-analyses checklist (PRISMA) guidelines. A complete search of PubMed, EMBASE and MEDLINE was undertaken. Twenty-four articles related to closure of soft tissue defects through acute limb shortening were identified and included in this review. Results: All report on restoration of limb function without or with minimal residual shortening. The authors note a decrease in the need for microsurgery. The external fixation devices used for deformity correction after closure of the soft tissue defect by acute shortening, angulation and rotation were the Ilizarov apparatus and circular fixator hexapods mainly. Conclusion: Acute shortening is an alternative to microsurgical techniques. A ring external fixator is useful for restoring limb alignment after closing the soft tissue defect through creating a temporary deformity. The use of circular fixator hexapods can enable accurate correction of complex multicomponent deformities without the need to reassembly of individual correction units. How to cite this article: Plotnikovs K, Movcans J, Solomin L. Acute Shortening for Open Tibial Fractures with Bone and Soft Tissue Defects: Systematic Review of Literature. Strategies Trauma Limb Reconstr 2022;17(1):44-54.

A 52-Year-Old Man with a Gustillo-Anderson IIIB Open Tibial Shaft Fracture with Extensive Soft-Tissue Defect Requiring Limb Salvage with Artificial Deformity-Creating Technique.

BACKGROUND In this case report, an alternative way of treating Gustillo-Anderson IIIB type fractures with severe soft-tissue damage is provided for cases where, for various reasons, it is not possible to close a soft-tissue defect with a flap. CASE REPORT An artificial deformity-creating technique was applied for a patient with a right distal tibial open fracture (Gustillo IIIB type) with complete tibial cartilage and bone loss of 10 cm and severe soft-tissue defect after high-energy trauma. This technique includes damaged limb shortening, translation, angulation, and rotation for closure of soft-tissue defects using orthopedic hexapod and bifocal bone transport without need for plastic surgery. Because of the timely planning and application of the orthopedic hexapod for the artificial deformity correction, the final alignment of the limb was close to the physiological standard and had good functional outcomes. Despite the extremely severe shortening and acute angles, the total treatment time was only 75 weeks. At the 1-year follow-up after treatment completion, the patient had good functional outcomes with the 36-Item Short Form Survey score: general health, 80%; physical functioning, 85%; and social functioning, 100%. CONCLUSIONS In conclusion, we show that the artificial deformity-creating with subsequent orthopedic hexapod application and lengthening of a limb is a robust method that can be applied even for the treatment of severe open fractures with significant soft-tissue damage and bone loss, which can be performed outside high-level trauma hospitals and has good clinical outcomes without significant complications.