Surgical Techniques For The Exposed Lower Limb Bones

Objectives: There were a great variety of reconstructive methods to restore the exposed lower limb bones.In this article,these patients suffered from the exposed lower limb bones were summed up to compare the dissimilar approaches in surgery.Subsequently,to reach a decision about the most suitable surgical technique for patients with different areas and sizes of exposed bones.Methods: There were 18 patients with the exposed lower limb bones who seek medical care in our department from October 2013 to December 2016.They were composed of 1 case who suffered from electric injury,12 cases who suffered from traffic accident injury,2 cases who were falling from a height,2 cases who were injured by falling objects,1 case who suffered from accidents of daily life.Area of the exposed lower limb bones: 11 cases were the tibia,3 cases were the calcaneus,3 cases were the ankle,1 case was metatarsal bone.These conventional reconstruction methods contained nonsurgical treatments(Vacuum Sealing Drainage or routine dressing),direct suture,skin grafts,local flaps transplantation,axial flap transplantation and free flap transplantation.As the complicated condition,the exposed lower limb bones were usually treated by combination therapies.In these 18 cases,1 patient received direct suture,2 patients received VSD vacuum sealing drainage combined with skin grafts,1 patient received VSD vacuum sealing drainage combined with local flaps transplantation,13 patients received VSD vacuum sealing drainage combined with skin grafts and axial flap transplantation,1 patient received skin grafts combined with axial flap transplantation.Collecting the 18 cases with clinical research of relevant data,such as the wound size after debridement,wound size,types of postoperative complications,hospitalization time,operation times,type of other diseases,etc.and then analyzing these data relied on the descripitive research.Results: After the debridement thoroughly,1 patient received direct suture,which repaired the wound in size of about 2cm×3cm,and the wound healed well after operation.2 patients received VSD vacuum sealing drainage combined with skin grafts,which repaired the wound in sizes of about 3cm×3cm and 3cm×4cm,and all the grafts survived.The two patients got satisfactory treatment effect.1 patient received VSD vacuum sealing drainage combined with local flaps transplantation,which repaired the wound in size of about 1.5cm×1.5cm,and partially necrosis of local flap occurred,which closed the wound after another debridement and suture.13 patients received VSD vacuum sealing drainage combined with skin grafts and axial flap transplantation,which repaired the wound in minimum size of about 1cm×1cm and in maximum size of about10cm×20cm.Some cells in distal part of local flap died in 2 cases,and then caused the tissue defect.The tissue defect areas were repaired by the means of wound debridement combined with VSD vacuum sealing drainage.All the transplanted flap were survived,with no dysfunction,no lower limb walking function disorder,and all the patients were satisfied with the treatment in the postoperative follow-up stage of 3 month,6 month and 12 month.1 patient received skin grafts combined with skin grafts and axial flap transplantation,which repaired the wound in size of about 1.5cm×6cm,and a part of local flap necrosis took place after surgery,which healed after regular dressings.Conclusions: The location of bone exposure,size,local tissue conditions,the overall health,as well as the patient's willingness are advised in selecting the best approach to restore the wound.At present,direct suture is suitable for the wound of small size after debridement,which can be suture without tension.Skin grafts transplantation is mainly used in the repair of dorsal and plantar non weight-bearing bone exposure.The local flaps transplantation or axial flap transplantation are effective in closing the wound which located in the anterior tibia region,plantar,and larger area after debridement.If the axial flap cannot be used or the area are too larger,doctor can select free flap to transplant.Complex or refractory exposed lower limb bones in the patients,with stable vital systemic,body infection control,thorough debridement,should early receive VSD vacuum sealing drainage or conventional dressing to promote the growth of granulation.After the granulation covered the wound,combined with skin grafts and axial flap transplantation can be selected to get satisfactory treatment.