Tissue flap combined with sequential bone lengthening technique for repairing severe soft tissue and bone defects of lower extremity after burn injury_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 SHENYuming ¹ , CHENHui ¹ , HUXiaohua ¹ , HUANGLei ² , MAChunxu ¹

1. Department of Burns, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China;
2. Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China;

Corresponding author：

SHENYuming, Email: shenyuming1963@163.com

Keywords：

Lower limb; bone defect; soft tissue defect; tissue flap grafting; bone lengthening

DOI：

10.7507/1002-1892.201609117

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the effectiveness of tissue flap grafting and sequential bone lengthening for repairing severe soft tissue and bone defects of the lower extremity after burn injury. Methods Between January 2010 and December 2015, 11 cases of large segmental bone and soft tissue defects in the leg were treated. There were 10 males and 1 female, with a mean age of 28 years (range, 19-37 years). The causes included traffic accident in 8 cases, high voltage electric burn in 2 cases, CO poisoning burn in 1 case. The time from injury to admission was 3-14 days (mean, 6.5 days). The bone defect length was 8-18 cm (mean,14 cm); the skin soft tissue defect ranged from 13 cm × 8 cm to 25 cm × 19 cm. After complete removal of necrotic tissue and lesions of the femur or the tibia, the tissue flaps were used to repair soft tissue defect of the lower extremity in one-stage operation; bone defect was treated by Orthofix single side external fixation or Ilizarov ring external fixation in two-stage operation. Results Eleven flaps survived completely, primary healing of incision was obtained in the others except for 1 patient who had necrotic bone infection, which was cured after removing necrosed femoral bone and filling with antibiotic bone cement spacer. During bone lengthening, pin tract infection occurred in 1 patient, and infection was controlled after dressing change. Bone lengthening ranged from 8 to 18 cm, with an average of 14 cm. After prolonged extension, the external fixator was retained for 4-12 months (mean, 6.5 months). All bone defects were repaired with bone healing time of 12-22 months (mean, 17 months). All patients were followed up 8-24 months (mean, 15 months). No vascular and neurological complication occurred during operation; no osteomyelitis or re-fracture occurred after operation, and the recovery of the lower extremity function was good. Conclusion Tissue flap grafting combined with bone lengthening is an effective method to repair severe bone and soft tissue defects of lower extremity.

Citation： SHENYuming, CHENHui, HUXiaohua, HUANGLei, MAChunxu. Tissue flap combined with sequential bone lengthening technique for repairing severe soft tissue and bone defects of lower extremity after burn injury. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(2): 160-164. doi: 10.7507/1002-1892.201609117 Copy

1.	成亮, 徐佳, 柴益民, 等. 单边外固定支架与环形外固定支架骨搬运治疗下肢长干骨缺损的疗效及并发症比较. 中华创伤骨科杂志, 2015, 17(10): 863-867.
2.	马翔宇, 王东. 开放性骨折修复: 创面感染、植入物选择及预后评价. 中国组织工程研究, 2015, 17(26): 4258-4264.
3.	肖樵苏, 张先文, 叶俊武, 等. 应用骨搬运术同期治疗合并难治性软组织缺损的胫骨大段骨缺损. 中国修复重建外科杂志, 2016, 30(8): 961-964.
4.	余斌. 开放性骨折治疗进展. 国际骨科学杂志, 2013, 34(1): 6-10.
5.	Hutson JJ, Dayicioglu D, Oeltjen JC, et al. The treatment of gustilo grade IIIB tibia fractures with application of antibiotic spacer, flap, and sequential distraction osteogenesis. Ann Plast Surg, 2010, 64(5): 541-552.
6.	Robert Rozbruch S, Weitzman AM, Waston JT, et al. Simultaneous treatment of tibial bone and soft-tissue defect with the Ilizarov method. J Orthop Trauma, 2006, 20(3): 197-205.
7.	沈余明, 于东宁, 胡骁骅, 等. 逆行缝匠肌肌皮瓣修复小腿难愈创面. 中华烧伤杂志, 2011, 27(3): 222-224.
8.	黄雷, 谢明, 王金辉, 等. 应用Orthofix重建外固定架治疗骨缺损. 中华创伤骨科杂志, 2004, 6(10): 1096-1101.
9.	Gopal S, Majumder S, Batchelor AG, et al. Fix and flap: the radical orthopaedic and plastic treatment of severe open fracture of tibia. J Bone Joint Surg (Br), 2000, 82(7): 959-966.
10.	Griffith MH, Gardner MJ, Blyakher A, et al. Traumatic segmental bone loss in a pediatric patient treated with bifocal bone transport. J Orthop Trauma, 2007, 21(4): 347-351.
11.	Green SA. Skeletal defects. A comparison of bone grafting and bone transport for segmental skeletal defects. Clin Orthop Relat Res, 1994, (301): 111-117.
12.	DeCoster TA, Gehlert RJ, Mikola EA, et al. Management of posttraumatic segmental bone defects. J Am Acad Orthop Surg, 2004, 12(1): 28-38.
13.	Oh CW, Song HR, Roh JY, et al. Bone transport over an intramedullary nail for reconstruction of long bone defects in tibia. Arch Orthop Trauma Surg, 2008, 128: 801-808.
14.	Masquelet AC, Fitoussi F, Begue T, et al. Reconstruction of the long bones by the induced membrane and spongy autograft. Ann Chir Plast Esthet, 2000, 45(3): 346-353.
15.	李宗原, 唐诗添, 王军, 等. Masquelet技术联合组织瓣移植修复骨软组织复合缺损. 中国修复重建外科杂志, 2016, 30(8): 966-969.
16.	蒋守海, 邱东新, 董长红, 等. 应用Ilizarov技术Ⅰ期修复伴有皮肤缺损的胫骨创伤性骨髓炎骨缺损. 中国骨伤, 2015, 28(12): 1125-1128.
17.	Chim H, Sontich JK, Kaufman BR. Free tissue transfer with distraction osteogenesis is effective for limb salvage of the infected traumatized lower extremity. Plast Reconstr Surg, 2011, 127(6): 2364-2372.
18.	Lowenberg DW, Feibel RJ, Louie KW, et al. Combined muscle flap and Ilizarov reconstruction for bone and soft tissue defects. Clin Orthop Relat Res, 1996, 332(1): 37-51.
19.	沈余明, 韩冬, 覃凤均. 人工全膝关节置换术后切口缘皮肤坏死的修复. 中国修复重建外科杂志, 2014, 28(8): 985-987.
20.	Byrd HS, Cierny G 3rd, Tebbetts JB. The management of open tibial fractures with associated soft-tissue loss: External pin fixation with early flap coverage. Plast Reconstr Surg, 1981, 68(1): 73-82.
21.	丛海波, 王晓科, 丁英杰, 等. 组织瓣移植结合骨搬运修复重建小腿大范围复合组织缺损. 中华创伤骨科杂志, 2014, 16(6): 461-464.

1. 成亮, 徐佳, 柴益民, 等. 单边外固定支架与环形外固定支架骨搬运治疗下肢长干骨缺损的疗效及并发症比较. 中华创伤骨科杂志, 2015, 17(10): 863-867.
2. 马翔宇, 王东. 开放性骨折修复: 创面感染、植入物选择及预后评价. 中国组织工程研究, 2015, 17(26): 4258-4264.
3. 肖樵苏, 张先文, 叶俊武, 等. 应用骨搬运术同期治疗合并难治性软组织缺损的胫骨大段骨缺损. 中国修复重建外科杂志, 2016, 30(8): 961-964.
4. 余斌. 开放性骨折治疗进展. 国际骨科学杂志, 2013, 34(1): 6-10.
5. Hutson JJ, Dayicioglu D, Oeltjen JC, et al. The treatment of gustilo grade IIIB tibia fractures with application of antibiotic spacer, flap, and sequential distraction osteogenesis. Ann Plast Surg, 2010, 64(5): 541-552.
6. Robert Rozbruch S, Weitzman AM, Waston JT, et al. Simultaneous treatment of tibial bone and soft-tissue defect with the Ilizarov method. J Orthop Trauma, 2006, 20(3): 197-205.
7. 沈余明, 于东宁, 胡骁骅, 等. 逆行缝匠肌肌皮瓣修复小腿难愈创面. 中华烧伤杂志, 2011, 27(3): 222-224.
8. 黄雷, 谢明, 王金辉, 等. 应用Orthofix重建外固定架治疗骨缺损. 中华创伤骨科杂志, 2004, 6(10): 1096-1101.
9. Gopal S, Majumder S, Batchelor AG, et al. Fix and flap: the radical orthopaedic and plastic treatment of severe open fracture of tibia. J Bone Joint Surg (Br), 2000, 82(7): 959-966.
10. Griffith MH, Gardner MJ, Blyakher A, et al. Traumatic segmental bone loss in a pediatric patient treated with bifocal bone transport. J Orthop Trauma, 2007, 21(4): 347-351.
11. Green SA. Skeletal defects. A comparison of bone grafting and bone transport for segmental skeletal defects. Clin Orthop Relat Res, 1994, (301): 111-117.
12. DeCoster TA, Gehlert RJ, Mikola EA, et al. Management of posttraumatic segmental bone defects. J Am Acad Orthop Surg, 2004, 12(1): 28-38.
13. Oh CW, Song HR, Roh JY, et al. Bone transport over an intramedullary nail for reconstruction of long bone defects in tibia. Arch Orthop Trauma Surg, 2008, 128: 801-808.
14. Masquelet AC, Fitoussi F, Begue T, et al. Reconstruction of the long bones by the induced membrane and spongy autograft. Ann Chir Plast Esthet, 2000, 45(3): 346-353.
15. 李宗原, 唐诗添, 王军, 等. Masquelet技术联合组织瓣移植修复骨软组织复合缺损. 中国修复重建外科杂志, 2016, 30(8): 966-969.
16. 蒋守海, 邱东新, 董长红, 等. 应用Ilizarov技术Ⅰ期修复伴有皮肤缺损的胫骨创伤性骨髓炎骨缺损. 中国骨伤, 2015, 28(12): 1125-1128.
17. Chim H, Sontich JK, Kaufman BR. Free tissue transfer with distraction osteogenesis is effective for limb salvage of the infected traumatized lower extremity. Plast Reconstr Surg, 2011, 127(6): 2364-2372.
18. Lowenberg DW, Feibel RJ, Louie KW, et al. Combined muscle flap and Ilizarov reconstruction for bone and soft tissue defects. Clin Orthop Relat Res, 1996, 332(1): 37-51.
19. 沈余明, 韩冬, 覃凤均. 人工全膝关节置换术后切口缘皮肤坏死的修复. 中国修复重建外科杂志, 2014, 28(8): 985-987.
20. Byrd HS, Cierny G 3rd, Tebbetts JB. The management of open tibial fractures with associated soft-tissue loss: External pin fixation with early flap coverage. Plast Reconstr Surg, 1981, 68(1): 73-82.
21. 丛海波, 王晓科, 丁英杰, 等. 组织瓣移植结合骨搬运修复重建小腿大范围复合组织缺损. 中华创伤骨科杂志, 2014, 16(6): 461-464.

Chinese Journal of Reparative and Reconstructive Surgery

Tissue flap combined with sequential bone lengthening technique for repairing severe soft tissue and bone defects of lower extremity after burn injury

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content