The Combined Use Of Microsurgery And Ilizarov Technique In Treatment Of Gustilo-Anderson Type ⅢC Injuries In Calf

ObjectiveTo introduce the surgical technique and clinical outcomes of microsurgery technique combined with ilizarov technique in treatment of Gustilo-Anderson type IIIC injuries in calf.MethodsTwenty-one patients were identified from a retrospective review from July,2012 to March,2018 who suffered severely destruction wound in calf.There were 15 males and 6 females aged from 13 to 67 years old(average 42 years old).By Gustilo classification,21 cases were all type ⅢC.The defects of the anterior tibial soft tissue ranged from 9 cm x 7 cm to 28 cm x 13 cm in area;the tibial defects ranged from 5 cm to 13cm(average,9.3 cm)in length.The schemes of calf salvage depended on the severity of damage.Tissue flap transplantation combined with the main vascular bridge anastomosis and bone transport was adopted in 16 cases,while arterial anastomosis combined with bone and skin synchronous transport was adopted in 5 cases.Ilizarov external fixator was applied 6 to 8 weeks after the tissue flap transplantation in 13 cases,and 10 weeks in 3 cases.Bone tissue and soft tissue were transported simultaneously in 4 weeks after limb revascularization.Regular outpatient reexamination after discharge,main contents: wound healing,local infection and nail infection,deviation of sliding bone segment,and adjustment of moving speed according to new bone mineralization.ResultsThe tibiae united in all the 21 cases.The docking site was bony healing after rapid compression in 11 cases.Delayed union of the fracture ends was observed in 10 cases,7 cases were healed by accordion technique,and 3 cases achieved bony healing by grafting autogenous cancellous bone.All patients were followed up for 18-33 months(average 23.7 months).According to ASAMI fracture healing score,5 cases were excellent,11 were good,5 was fair,yielding an excellent to good rate of 76.2%(16/21).ConclusionThe combined use of microsurgery and ilizarov technique can obtain satisfactory clinical effect in the salvage of severely mangled calf.