APPLICATION OF ONE STAGE VACUUM SEALING DRAINAGE COMBINED WITH BI-PEDICLE SLIDING FLAP TRANSPLANTATION FOR OPEN TIBIOFIBULAR FRACTURE AND SOFT TISSUE DEFECTS OF THE LOWER LEG_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YEGuoqiang ¹ , FUGuo ² ,  QIJian ²

1. Department of Orthopedic Trauma and Microsurgery, the Orthopedic Hospital Affiliated to Guangdong University of Traditional Chinese Medicine, Guangzhou Guangdong, 510240, P. R. China;
2. Department of Hand Surgery, Orthopedic Trauma and Microsurgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou Guangdong, 510240, P. R. China;

Corresponding?author：

QIJian, Email: speedsnow@126.com

Keywords：

acuum sealing drainage; Bi-pedicle sliding flap; Open fracture; Tibiofibular fracture; Soft tissue defect

DOI：

10.7507/1002-1892.20150206

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Objective To evaluate the effectiveness of one stage vacuum sealing drainage (VSD) combined with bi-pedicle sliding flap transplantation in repairing open tibiofibular fracture and soft tissue defects of the lower leg. Methods Twenty-five patients with open tibiofibular fracture and soft tissue defects of the lower leg were treated by VSD combined with bi-pedicle sliding flap transplantation between January 2012 and July 2014. There were 18 males and 7 females, aged 12-65 years (mean, 35.2 years). The injury causes included traffic accident injury (20 cases), falling injury from height (3 cases), and heavy pound injury (2 cases). The left side was involved in 14 cases, the right side in 8 cases, and both sides in 3 cases. According to Gustilo classification, injury was rated as type II (6 lower extremities), type III a (19 lower extremities), and type III b (3 lower extremities). The anterior tibial defect area after debridement ranged from 6 cm×3 cm to 12 cm×5 cm. The course of injury and admission was 1-18 hours (mean, 4.5 hours). An anterior tibial bi-pedicle sliding flap of 24 cm×6 cm to 48 cm×8 cm was designed to cover the wound and tibia fracture was fixed with minimally invasive internal fixation. After suturing the anterior tibial wound without tension, the flap was transferred forward. The exposed fibula was fixed with reconstruction plate. The remained wound was covered by VSD. Continuously antibiotic saline irrigation was applied postoperatively. After 15 days, the VSD dressing was removed and free skin graft was used to cover the remained wound. Results After the VSD dressing was removed, the wounds and tension-reduced wound of 18 lower extremities completely healed. Unhealing wounds were covered by skin graft in 9 lower extremities. Infection occurred in 1 lower extremity and was cured after treated with antibiotics. All the wounds healed and flaps survived. The patients were followed up 6-24 months (mean, 18 months). The fractures union was confirmed by X-ray and the average union time was 3.2 months (range, 2.5-5 months). Conclusion The application of one stage VSD combined with bi-pedicle sliding flap transposition is a simple and safe treatment regimen for Gustilo type II-IIIa open tibiofibular fracture and soft tissue defects of the lower leg. It has the advantages of few complications and low costs, short hospitalization, and good effectiveness.

Citation： YEGuoqiang, FUGuo, QIJian. APPLICATION OF ONE STAGE VACUUM SEALING DRAINAGE COMBINED WITH BI-PEDICLE SLIDING FLAP TRANSPLANTATION FOR OPEN TIBIOFIBULAR FRACTURE AND SOFT TISSUE DEFECTS OF THE LOWER LEG. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(8): 955-958. doi: 10.7507/1002-1892.20150206 Copy

1.	Ashraf MO,Jones HM,Kanvinde R.Acute traumatic fracture dislocation of proximal tibiofibular joint:Case report and literature review.Injury,2015,46(7):1400-1402.
2.	Zhang Y,Zhuang Y,Wang B,et al.Single-incision approach improves wound healing and bone union for treating mid-to-lower segment of tibiofibular fracture.Int J Clin Exp Med,2015,8(3):4269-4274.
3.	Wang D,Xiang JP,Chen XH,et al.A meta-analysis for postoperative complications in tibial plafond fracture:open reduction and internal fixation versus limited internal fixation combined with external fixator.J Foot Ankle Surg,2015,54(4):646-651.
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5.	Penn-Barwell JG,Myatt RW,Bennett PM,et al.Medium-term outcomes following limb salvage for severe open tibia fracture are similar to trans-tibial amputation.Injury,2015,46(2):288-291.
6.	Nemoto M,Ishikawa S,Kounoike N,et al.Free flap transfer to preserve main arterial flow in early reconstruction of open fracture in the lower extremity.Plast Surg Int,2015,2015:213892.
7.	Sood A,Khamsi B,Datiashvili R,et al.Use of cross-leg flap for wound complications resulting from open pilon fracture.Am J Orthop (Belle Mead NJ),2015,44(3):131-134.
8.	Pérez-Rivera OM,Palanco-Domínguez LE,Ortiz-Rivera T,et al.Internal and external fixation for open tibial fracture.Case presentation.Acta Ortop Mex,2013,27(4):256-259.
9.	Wei SJ,Cai XH,Wang HS,et al.A comparison of primary and delayed wound closure in severe open tibial fractures initially treated with internal fixation and vacuum-assisted wound coverage:a case-controlled study.Int J Surg,2014,12(7):688-694.
10.	van Dreumel RL,van Wunnik BP,Janssen L,et al.Mid-to long-term functional outcome after open reduction and internal fixation of tibial plateau fractures.Injury,2015.[Epub ahead of print].
11.	Katsumura T,Hirase Y,Fukumoto K,et al.Use of free ipsilateral gastrocnemius flap for coverage of distal third tibial defect after Gustilo type Ⅲ open fracture.J Reconstr Microsurg,2013,29(2):113-116.
12.	Cheng HT,Hsu YC,Wu CI.Risk of infection with delayed wound coverage by using negative-pressure wound therapy in Gustilo Grade ⅢB/ⅢC open tibial fracture:an evidence-based review.J Plast Reconstr Aesthet Surg,2013,66(6):876-878.
13.	韓立仁,趙北,穆衛東,等.外固定架加鋼板治療伴有脛骨骨缺損的開放性脛腓骨骨折.中華創傷雜志,2013,29(3):258-261.
14.	陸男吉,鐘永翔,文根,等.遠端蒂隱神經營養血管皮瓣聯合封閉負壓吸引技術在脛骨遠端鋼板外露中的臨床應用.中華顯微外科雜志,2012,35(6):457-459.
15.	楊欽泰,李曉文,歐春培,等.骨筋膜室綜合征的早期診斷與治療.中華創傷骨科雜志,2009,11(7):691-692.
16.	劉桂花,陳坤峰,趙志堅,等.負壓封閉引流配合腓腸肌皮瓣移植治療脛骨外露創面.中華顯微外科雜志,2011,34(4):326-327.
17.	杜全紅,叢海波,史永安,等.封閉式負壓引流技術聯合開放植骨治療脛骨創傷性骨髓炎.中國修復重建外科雜志,2014,28(5):562-565.
18.	楊佐明,劉曉明,戴士峰,等.脛腓骨骨折術后感染的治療分析.中國修復重建外科雜志,2011,25(9):1151-1152.

1. Ashraf MO,Jones HM,Kanvinde R.Acute traumatic fracture dislocation of proximal tibiofibular joint:Case report and literature review.Injury,2015,46(7):1400-1402.
2. Zhang Y,Zhuang Y,Wang B,et al.Single-incision approach improves wound healing and bone union for treating mid-to-lower segment of tibiofibular fracture.Int J Clin Exp Med,2015,8(3):4269-4274.
3. Wang D,Xiang JP,Chen XH,et al.A meta-analysis for postoperative complications in tibial plafond fracture:open reduction and internal fixation versus limited internal fixation combined with external fixator.J Foot Ankle Surg,2015,54(4):646-651.
4. Rodrigues FL,de Abreu LC,Valenti VE,et al.Bone tissue repair in patients with open diaphyseal tibial fracture treated with biplanar external fixation or reamed locked intramedullary nailing.Injury,2014,45 Suppl 5:S32-S35.
5. Penn-Barwell JG,Myatt RW,Bennett PM,et al.Medium-term outcomes following limb salvage for severe open tibia fracture are similar to trans-tibial amputation.Injury,2015,46(2):288-291.
6. Nemoto M,Ishikawa S,Kounoike N,et al.Free flap transfer to preserve main arterial flow in early reconstruction of open fracture in the lower extremity.Plast Surg Int,2015,2015:213892.
7. Sood A,Khamsi B,Datiashvili R,et al.Use of cross-leg flap for wound complications resulting from open pilon fracture.Am J Orthop (Belle Mead NJ),2015,44(3):131-134.
8. Pérez-Rivera OM,Palanco-Domínguez LE,Ortiz-Rivera T,et al.Internal and external fixation for open tibial fracture.Case presentation.Acta Ortop Mex,2013,27(4):256-259.
9. Wei SJ,Cai XH,Wang HS,et al.A comparison of primary and delayed wound closure in severe open tibial fractures initially treated with internal fixation and vacuum-assisted wound coverage:a case-controlled study.Int J Surg,2014,12(7):688-694.
10. van Dreumel RL,van Wunnik BP,Janssen L,et al.Mid-to long-term functional outcome after open reduction and internal fixation of tibial plateau fractures.Injury,2015.[Epub ahead of print].
11. Katsumura T,Hirase Y,Fukumoto K,et al.Use of free ipsilateral gastrocnemius flap for coverage of distal third tibial defect after Gustilo type Ⅲ open fracture.J Reconstr Microsurg,2013,29(2):113-116.
12. Cheng HT,Hsu YC,Wu CI.Risk of infection with delayed wound coverage by using negative-pressure wound therapy in Gustilo Grade ⅢB/ⅢC open tibial fracture:an evidence-based review.J Plast Reconstr Aesthet Surg,2013,66(6):876-878.
13. 韓立仁,趙北,穆衛東,等.外固定架加鋼板治療伴有脛骨骨缺損的開放性脛腓骨骨折.中華創傷雜志,2013,29(3):258-261.
14. 陸男吉,鐘永翔,文根,等.遠端蒂隱神經營養血管皮瓣聯合封閉負壓吸引技術在脛骨遠端鋼板外露中的臨床應用.中華顯微外科雜志,2012,35(6):457-459.
15. 楊欽泰,李曉文,歐春培,等.骨筋膜室綜合征的早期診斷與治療.中華創傷骨科雜志,2009,11(7):691-692.
16. 劉桂花,陳坤峰,趙志堅,等.負壓封閉引流配合腓腸肌皮瓣移植治療脛骨外露創面.中華顯微外科雜志,2011,34(4):326-327.
17. 杜全紅,叢海波,史永安,等.封閉式負壓引流技術聯合開放植骨治療脛骨創傷性骨髓炎.中國修復重建外科雜志,2014,28(5):562-565.
18. 楊佐明,劉曉明,戴士峰,等.脛腓骨骨折術后感染的治療分析.中國修復重建外科雜志,2011,25(9):1151-1152.

Chinese Journal of Reparative and Reconstructive Surgery

APPLICATION OF ONE STAGE VACUUM SEALING DRAINAGE COMBINED WITH BI-PEDICLE SLIDING FLAP TRANSPLANTATION FOR OPEN TIBIOFIBULAR FRACTURE AND SOFT TISSUE DEFECTS OF THE LOWER LEG

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