TIBIAL PERIOSTEAL FLAP PEDICLED WITH INTERMUSCULAR BRANCH OF POSTERIOR TIBIAL VESSELS COMBINED WITH AUTOLOGOUS BONE GRAFT FOR TIBIAL BONE DEFECT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

NIYulong ,  GAOShunhong , ZHANGJingyu , DONGHuishuang , ZHANGYunpeng , FUJiansong

No. 2 Department of Hand Surgery, the Second Hospital of Tangshan(North China University of Science and Technology Affilated Orthopedic Hospital), Tangshan Hebei, 063000, P. R. China;

Corresponding?author：

GAOShunhong, Email: gshdj@126.com

Keywords：

Posterior tibial vessel; Periosteal flap; Tibial bone defect; Soft tissue defect; Bone transplantation; Repair

DOI：

10.7507/1002-1892.20150265

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Objective To investigate the effectiveness of tibial periosteal flap pedicled with intermuscular branch of posterior tibial vessels combined with autologous bone graft in the treatment of tibial bone defects. Methods Between January 2007 and December 2013, 19 cases of traumatic tibia bone and soft tissue defects were treated. There were 14 males and 5 females, aged from 18 to 49 years (mean, 28 years). The tibial fracture site located at the middle tibia in 6 cases and at the distal tibia in 13 cases. According to Gustilo type, 4 cases were rated as type Ⅲ A, 14 cases as type Ⅲ B, and 1 case as type Ⅲ C (injury of anterior tibial artery). The length of bone defect ranged from 4.3 to 8.5 cm (mean, 6.3 cm). The soft tissue defects ranged from 8 cm×5 cm to 17 cm×9 cm. The time from injury to operation was 3 to 8 hours (mean, 4 hours). One-stage operation included debridement, external fixation, and vacuum sealing drainage. After formation of granulation tissue, the fresh wound was repaired with sural neurovascular flap or posterior tibial artery perforator flap. The flap size ranged from 10 cm×6 cm to 19 cm×11 cm. In two-stage operation, tibial periosteal flap pedicled with intermuscular branch of posterior tibial vessels combined with autologous bone graft was used to repair tibial defect. The periosteal flap ranged from 6.5 cm×4.0 cm to 9.0 cm×5.0 cm; bone graft ranged from 4.5 to 9.0 cm in length. External fixation was changed to internal fixation. Results All flaps survived with soft texture, and no ulcer and infection occurred. All incisions healed by the first intention. All patients were followed up 18-40 months (mean, 22.5 months). All graft bone healed, with the healing time from 3 to 9 months (mean, 6.5 months). No complication of implant loosening or fracture was observed. No pain and abnormal activity in the affected leg occurred. All patients resumed weight-bearing and walking function. The length of the limb was recovered and difference value was 0.5-1.5 cm between normal and affected sides. The function of the knee and ankle joint was good without infection, malunion, and equinus. According to the Johner standard at last follow-up, the results were excellent in 15 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate of 94.7%. Conclusion Tibial periosteal flap pedicled with intermuscular branch of posterior tibial vessels combined with autologous bone graft is an effective method to treat bone defect of the tibia.

Citation： NIYulong, GAOShunhong, ZHANGJingyu, DONGHuishuang, ZHANGYunpeng, FUJiansong. TIBIAL PERIOSTEAL FLAP PEDICLED WITH INTERMUSCULAR BRANCH OF POSTERIOR TIBIAL VESSELS COMBINED WITH AUTOLOGOUS BONE GRAFT FOR TIBIAL BONE DEFECT. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(10): 1221-1225. doi: 10.7507/1002-1892.20150265 Copy

1.	陳振光. 帶血供脛骨骨膜瓣移位術的解剖與臨床應用. 中華顯微外科雜志, 2000, 23(2):157-159.
2.	侯春林. 自體組織移植進展. 中國修復重建外科雜志, 2006, 20(4): 309-312.
3.	Cavadas PC, Landín L, Ibá?ez J, et al. Reconstruction of major traumatic segmental bone defects of the tibia with vascularized bone transfers. Plast Reconstr Surg, 2010, 125(1):215-223.
4.	王華, 孟琳, 馬華, 等. 腓淺血管筋膜蒂脛腓骨膜瓣治療脛骨骨不連. 中國修復重建外科雜志, 2009, 23(11):1326-1328.
5.	Johner R, Wrueh O. Classification of tibial shaft fractures and correlation with results after rigid fixation. Clin Orthop Relat Res, 1983, (178):7-25.
6.	陳振光, 張發惠, 余國榮, 等. 帶血供脛骨內側面骨膜瓣移位術. 中華實驗外科雜志, 1997, 14(6):349-350.
7.	Masquelet AC, Roman MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves anatomic study and clinical experience in the leg. Plast Reconstr Surg, 1992, 89(6): 1115-1121.
8.	徐永清, 朱躍良, 范新宇, 等. 二處截骨骨搬移治療脛骨大段骨缺損合并軟組織缺損. 中華創傷骨科雜志, 2012, 14(10):831-834.
9.	Robert Rozbruch S, Weitzman AM, Tracey Watson J, et al. Simultaneous treatment of tibial bone and soft-tissue defects with the ilizarov method. J Orthop Trauma, 2006, 20(3):197-205.
10.	劉會仁, 王立新, 張艷茂, 等. 組織移植結合骨滑移治療小腿皮膚軟組織伴大段脛骨缺損. 中國修復重建外科雜志, 2013, 27(3): 295-298.
11.	Sala F, Thabet AM, Castelli F, et al. Bone transport for postinfectious segmental tibial bone defects with a combined ilizarov/taylor spatial frametechnique. J Orthop Trauma, 2011, 25(3):162-168.
12.	殷渠東, 孫振中, 顧三軍, 等. 骨搬運與骨短縮-延長治療脛骨骨缺損合并軟組織缺損的療效比較. 中國修復重建外科雜志, 2014, 28(7):818-822.
13.	謝武昆, 楊徘, 崔杰, 等. 鎖定接骨板自體髂骨移植治療老年脛腓骨中下段粉碎性骨折. 臨床骨科雜志, 2012, 15(6):661-662.
14.	胥少汀, 葛寶豐, 徐印坎. 實用骨科學. 4版. 北京:人民軍醫出版社, 2012:1167-1168.
15.	Soldado F, Knorr J, Haddad S, et al. Vascularized tibial periosteal graft in complex cases of bone nonunion in children. J Microsurgery, 2015, 35(3):239-243.
16.	Choudry UH, Bakri K, Moran SL, et al. The vascularized medial femoral condyle periosteal bone flap for the treatment of recalcitrant bony nonunions. J Ann Plast Surg, 2008, 60(2):174-180.
17.	毛莉穎, 黃東, 吳偉熾, 等. 帶監測皮島的脛前動脈穿支骨膜瓣在骨不連治療中的應用. 中華顯微外科雜志, 2013, 36(2):194-195.
18.	V?gelin E, Jones NF, Huang JI, et al. Healing of a critical-sized defect in the rat femur with use of a vascularized periosteal flap, a biodegradable matrix, and bone morphogenetic protein. J Bone Joint Surg (Am), 2005, 87(6):1323-1331.

1. 陳振光. 帶血供脛骨骨膜瓣移位術的解剖與臨床應用. 中華顯微外科雜志, 2000, 23(2):157-159.
2. 侯春林. 自體組織移植進展. 中國修復重建外科雜志, 2006, 20(4): 309-312.
3. Cavadas PC, Landín L, Ibá?ez J, et al. Reconstruction of major traumatic segmental bone defects of the tibia with vascularized bone transfers. Plast Reconstr Surg, 2010, 125(1):215-223.
4. 王華, 孟琳, 馬華, 等. 腓淺血管筋膜蒂脛腓骨膜瓣治療脛骨骨不連. 中國修復重建外科雜志, 2009, 23(11):1326-1328.
5. Johner R, Wrueh O. Classification of tibial shaft fractures and correlation with results after rigid fixation. Clin Orthop Relat Res, 1983, (178):7-25.
6. 陳振光, 張發惠, 余國榮, 等. 帶血供脛骨內側面骨膜瓣移位術. 中華實驗外科雜志, 1997, 14(6):349-350.
7. Masquelet AC, Roman MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves anatomic study and clinical experience in the leg. Plast Reconstr Surg, 1992, 89(6): 1115-1121.
8. 徐永清, 朱躍良, 范新宇, 等. 二處截骨骨搬移治療脛骨大段骨缺損合并軟組織缺損. 中華創傷骨科雜志, 2012, 14(10):831-834.
9. Robert Rozbruch S, Weitzman AM, Tracey Watson J, et al. Simultaneous treatment of tibial bone and soft-tissue defects with the ilizarov method. J Orthop Trauma, 2006, 20(3):197-205.
10. 劉會仁, 王立新, 張艷茂, 等. 組織移植結合骨滑移治療小腿皮膚軟組織伴大段脛骨缺損. 中國修復重建外科雜志, 2013, 27(3): 295-298.
11. Sala F, Thabet AM, Castelli F, et al. Bone transport for postinfectious segmental tibial bone defects with a combined ilizarov/taylor spatial frametechnique. J Orthop Trauma, 2011, 25(3):162-168.
12. 殷渠東, 孫振中, 顧三軍, 等. 骨搬運與骨短縮-延長治療脛骨骨缺損合并軟組織缺損的療效比較. 中國修復重建外科雜志, 2014, 28(7):818-822.
13. 謝武昆, 楊徘, 崔杰, 等. 鎖定接骨板自體髂骨移植治療老年脛腓骨中下段粉碎性骨折. 臨床骨科雜志, 2012, 15(6):661-662.
14. 胥少汀, 葛寶豐, 徐印坎. 實用骨科學. 4版. 北京:人民軍醫出版社, 2012:1167-1168.
15. Soldado F, Knorr J, Haddad S, et al. Vascularized tibial periosteal graft in complex cases of bone nonunion in children. J Microsurgery, 2015, 35(3):239-243.
16. Choudry UH, Bakri K, Moran SL, et al. The vascularized medial femoral condyle periosteal bone flap for the treatment of recalcitrant bony nonunions. J Ann Plast Surg, 2008, 60(2):174-180.
17. 毛莉穎, 黃東, 吳偉熾, 等. 帶監測皮島的脛前動脈穿支骨膜瓣在骨不連治療中的應用. 中華顯微外科雜志, 2013, 36(2):194-195.
18. V?gelin E, Jones NF, Huang JI, et al. Healing of a critical-sized defect in the rat femur with use of a vascularized periosteal flap, a biodegradable matrix, and bone morphogenetic protein. J Bone Joint Surg (Am), 2005, 87(6):1323-1331.

Chinese Journal of Reparative and Reconstructive Surgery

TIBIAL PERIOSTEAL FLAP PEDICLED WITH INTERMUSCULAR BRANCH OF POSTERIOR TIBIAL VESSELS COMBINED WITH AUTOLOGOUS BONE GRAFT FOR TIBIAL BONE DEFECT

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