| BackgroundAs less soft tissue coverage and little mobility of the skin on the front of legs and feet,it is easily caused bone and/or tendons exposure after damages.For treatment the kind of damage,flap or bone-flap transformation were used.However,there were no simple and effective methods to treat the severe bone combined soft tissue defection,which were usually dealed with alternatively repeated debridement and large bone and flap transplantation.It takes a long time and the prognosis is not available.So,It is a vital task the trauma surgeons should be faced that finding a simple and effective method to treat the severe damage.ObjectiveTo compare the curative effect of induced membrane osteogenesis combined with skin flap transplantation and unilateral external fixation combined with granular cancellous bone graft in repairing open fracture of calf with bone defect,and provide experience for its clinical treatment.MethodsFrom May 2016 to May 2018,fifteen patients with open fracture and bone defections of calf caused by severe trauma were enrolled in our hospital,which was described as the observation group.There were 13 males and 2 females,aged from 17 to 48 years with an average of(35.3±7.9)years.The causation including traffic accident injury in 12 cases,heavy crushing injury in 1 case and crush injury of machine in 2 cases.Primary surgery: the wounds were debridement after admission.The bone defects were filled with antibiotic bone cement and the fracture were fixed with steel plate or external fixation if there were no signs of infection 1 week later.Then the wound was covered by local rotation skin flap and far free skin flap transplantation,ranged from 7.0cm×12.0cm-16.0cm×21.0cm.The length of the bone defect ranged from 5.2cm to 15.1cm with an average of(9.7± 2.8)cm.Secondary stage surgery: autologous bone grafting was performed after bone cement removed 8-12 weeks after primary surgery(average 10 weeks).At the same time,the clinical data of 12 patients with open calf fracture and bone defection treated with unilateral external fixation combined with granular cancellous bone transplantation from May 2013 to May 2016 were retrospectively analyzed,which were analyzed as control group.There were 10 males and 2 females,aged 15-50 years,with an average age of(37.1 ± 10.6)years.The causation including traffic accident injury in 10 cases,heavy crushing injury in 1 case and crush injury of machine in 1 case.The length of the bone defect after debridement was 4.9cm-13.2cm,average(9.2 ± 2.7)cm.The control group was treated with early debridement,external fixation,VSD coverage,granular cancellous bone grafting,and skin flap coverage.There was no statistical difference in age,length of bone defect and injury between the two groups.The wound healing status,infection rate,bone healing status and function of affected limbs were compared between the two groups.Results1.Comparison of wound healing status and infection rate between the two groups: In the observation group,among the 15 patients,13 cases of stage I wounds achieved grade A healing,2 cases had necrosis around the flap,healed after dressing change.There was no deep tissue infection.All the wounds achieved grade A healing post operation of stage II,and no infection occurred.In the control group,post operation of external fixation,8 cases achieved grade A healing,2 cases achieved grade B healing and 2 cases suffered infection,who healed after repeated dressing changes;post operation of the bone graft and skin flap coverage,9 cases achieved Grade A healing,2 cases had necrosis of transplanted flap and 1 case suffered deep tissue infection.The three cases healed after repeated debridement and dressing change.The wound healing status were higher and infection rate was lower in the observation group than those in the control group,and the difference was statistically significant(P <0.05).2.Comparison of bone healing and function of affected limbs between two groups: All cases in the two groups were followed up.The follow up period in the observation group was 18-24 months,with an average of(20.9±2.7)months.The bone defects were healed without complications such as infection and malunion post operation of bone graft reconstruction in the observation group,and the average time of bone healing was(7.9±1.2)months,ranging from 6 to 10 months.The bone defect healing grade was excellent,and the functions of ankle and knee joint were evaluated according to the Paley's score system.Among them,13 cases were excellent and 2 cases were good.The follow up period were 18-36 months in the control group,with an average of(25.8±4.9)months.The complications including nonunion in 2 cases and infection in 1 case post operation of bone reconstruction and flap transplantation surgery.The cases suffered with nonunion were healed by another bone transplantation and the patients with infection were healed by repeated debridement and several surgeries.All cases were healed between 12 to 27 months,average(18.9±5.3)months.The paley's score of the adjacent joints: excellent in 9 cases,good in 2 cases and poor in 1 case.There was significant difference in fracture healing time,bone defect healing grade and Paley's score between observation group and control group(P<0.05).ConclusionCompared with unilateral external fixation combined with granular cancellous bone graft in repairing open fracture of calf with bone defection,the induced membrane osteogenesis combined with skin flap transplantation can enhance the activity of adjacent joint,improve anti-infection ability and promote bone healing.It is an effective treatment method for open calf fractures and bone defects,and is worthy of clinical promotion and application. |
PDF Full Text Request