Flap combined with induced membrane technique in treatment of post-traumatic tibial osteomyelitis with soft tissue defect_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

FAN Jinzhu , CONG Fei , REN Xiaoyu , ZHANG Ke ,  SONG Tao

Department of Bone Microsurgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P. R. China;

Corresponding?author：

SONG Tao, Email: st0325@126.com

Keywords：

Tibial osteomyelitis; flap; induced membrane technique; bone defect; wound repair

DOI：

10.7507/1002-1892.202201031

Video：

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Objective To investigate the effectiveness of flap combined with induced membrane technique in treatment of post-traumatic tibial osteomyelitis with soft tissue defect. Methods A clinical data of 33 patients with post-traumatic tibial osteomyelitis with soft tissue defect who met the selection criteria between August 2015 and October 2018 was retrospectively analyzed. There were 21 males and 12 females. The age ranged from 19 to 70 years, with an average of 39 years. The osteomyelitis located in the upper 1/3 of tibia in 8 cases, in the middle 1/3 of tibia in 14 cases, and in the lower 1/3 of tibia in 11 cases. According to Cierny-Mader classification standard, 19 cases of osteomyelitis were type Ⅲ and 14 cases were type Ⅳ. The duration of osteomyelitis ranged from 2 months to 20 years (median, 3 months). In the first-stage operation, after radical debridement, the length of bone defect was 1.5-12.5 cm (mean, 5.0 cm) and the size of soft tissue defects ranged from 5 cm×4 cm to 15 cm×12 cm. Bone cement containing antibiotics was implanted into the bone defect and the personalized flap was used to repair the wound. After the wound healed at 6-8 weeks and the infection was controlled, bone grafting was performed to repair bone defects in the second-stage operation. Results The flaps survived completely after the first-stage operation in 29 cases. Partial necrosis of the flap occurred in 4 cases and healed after surgical dressing change. All the incisions healed by first intention after the second-stage operation. All patients were followed up 24-32 months (mean, 28 months). All the bone grafts healed after operation, and the radiographic healing time was 3-9 months (mean, 5 months). The clinical healing time was 4-14 months (mean, 8 months). There was no recurrence of osteomyelitis during follow-up. At last follow-up, according to Johner-Wruhs evaluation criteria, the limb function was excellent in 27 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 93.9%. Conclusion For the post-traumatic tibial osteomyelitis with soft tissue defect, the flap combined with induced membrane technique is a reliable and effective method and can effectively restore the function of lower limbs with satisfactory effectiveness.

Citation： FAN Jinzhu, CONG Fei, REN Xiaoyu, ZHANG Ke, SONG Tao. Flap combined with induced membrane technique in treatment of post-traumatic tibial osteomyelitis with soft tissue defect. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(5): 614-618. doi: 10.7507/1002-1892.202201031 Copy

1.	任義軍, 胡銳, 嚴立, 等. 組織移植結合Ilizarov骨牽張技術重建下肢骨與軟組織缺損. 中華顯微外科雜志, 2020, 43(3): 233-237.
2.	鮑丙波, 魏海峰, 宋家林, 等. 分期手術治療小腿Gustilo-Anderson ⅢC型骨折的療效. 中華創傷雜志, 2021, 37(5): 395-401.
3.	湯不器, 朱威宏. 創傷后骨髓炎的診治進展. 中南大學學報(醫學版), 2021, 46(11): 1290-1297.
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5.	石健, 楊曉勇, 陳星宇, 等. 膜誘導技術結合內固定分期治療股骨感染性骨不連. 中華創傷雜志, 2021, 37(6): 555-561.
6.	Viale GJ, Garabano G, Pesciallo C, et al. Structural allograft and induced membrane technique for treatment of 10-cm segmental femoral bone defect: A case report. JBJS Case Connect, 2021, 11(4): e21.00372. doi: 10.2106/JBJS.CC.21.00372.
7.	吳斗, 劉強. Masquelet技術修復骨缺損的實驗研究現狀和展望. 中華實驗外科雜志, 2020, 37(11): 1983-1987.
8.	謝利軍, 李杭, 潘志軍, 等. Masquelet誘導膜技術修復脛骨感染性缺損. 中華創傷骨科雜志, 2018, 20(10): 860-865.
9.	王俊杰, 婁朝暉. 降鈣素原、D-二聚體、C反應蛋白、血沉、血常規在創傷骨科患者圍手術期治療中的臨床意義. 中外醫療, 2020, 39(15): 47-49.
10.	Arshad Z, Lau EJ, Aslam A, et al. Management of chronic osteomyelitis of the femur and tibia: a scoping review. EFORT Open Rev, 2021, 6(9): 704-715.
11.	Cunningham BP, Brazina S, Morshed S, et al. Fracture healing: A review of clinical, imaging and laboratory diagnostic options. Injury, 2017, 48 Suppl 1: S69-S75.
12.	Fisher JS, Kazam JJ, Fufa D, et al. Radiologic evaluation of fracture healing. Skeletal Radiol, 2019, 48(3): 349-361.
13.	Balbachevsky D, Gomes PS, Credídio MV, et al. Intramedullary nail versus bridge plate in open tibial fractures-randomized clinical trial. Injury, 2021, 52(3): S77-S83.
14.	唐輝, 徐永清, 李春曉, 等. Ilizarov骨搬運技術結合病灶截骨治療Cierny-Mader Ⅳ型慢性脛骨骨髓炎. 中華創傷骨科雜志, 2018, 20(2): 105-111.
15.	Lenze U, Pohlig F, Knebel C, et al. Autologous fibula transplantation for reconstruction of bone defects. Orthopade, 2017, 46(8): 648-655.
16.	亢哲, 鄧宇, 屈文強, 等. 誘導膜技術與Ilizarov骨搬運技術治療下肢長骨感染性骨缺損臨床療效的Meta分析. 生物骨科材料與臨床研究, 2020, 17(5): 25-31.
17.	Morwood MP, Streufert BD, Bauer A, et al. Intramedullary nails yield superior results compared with plate fixation when using the Masquelet technique in the femur and tibia. J Orthop Trauma, 2019, 33(11): 547-552.
18.	Mauffrey C, Hake ME, Chadayammuri V, et al. Reconstruction of long bone infections using the induced membrane technique: Tips and tricks. J Orthop Trauma, 2016, 30(6): e188-e193.

1. 任義軍, 胡銳, 嚴立, 等. 組織移植結合Ilizarov骨牽張技術重建下肢骨與軟組織缺損. 中華顯微外科雜志, 2020, 43(3): 233-237.
2. 鮑丙波, 魏海峰, 宋家林, 等. 分期手術治療小腿Gustilo-Anderson ⅢC型骨折的療效. 中華創傷雜志, 2021, 37(5): 395-401.
3. 湯不器, 朱威宏. 創傷后骨髓炎的診治進展. 中南大學學報(醫學版), 2021, 46(11): 1290-1297.
4. Careri S, Vitiello R, Oliva MS, et al. Masquelet technique and osteomyelitis: innovations and literature review. Eur Rev Med Pharmacol Sci, 2019, 23(2 Suppl): 210-216.
5. 石健, 楊曉勇, 陳星宇, 等. 膜誘導技術結合內固定分期治療股骨感染性骨不連. 中華創傷雜志, 2021, 37(6): 555-561.
6. Viale GJ, Garabano G, Pesciallo C, et al. Structural allograft and induced membrane technique for treatment of 10-cm segmental femoral bone defect: A case report. JBJS Case Connect, 2021, 11(4): e21.00372. doi: 10.2106/JBJS.CC.21.00372.
7. 吳斗, 劉強. Masquelet技術修復骨缺損的實驗研究現狀和展望. 中華實驗外科雜志, 2020, 37(11): 1983-1987.
8. 謝利軍, 李杭, 潘志軍, 等. Masquelet誘導膜技術修復脛骨感染性缺損. 中華創傷骨科雜志, 2018, 20(10): 860-865.
9. 王俊杰, 婁朝暉. 降鈣素原、D-二聚體、C反應蛋白、血沉、血常規在創傷骨科患者圍手術期治療中的臨床意義. 中外醫療, 2020, 39(15): 47-49.
10. Arshad Z, Lau EJ, Aslam A, et al. Management of chronic osteomyelitis of the femur and tibia: a scoping review. EFORT Open Rev, 2021, 6(9): 704-715.
11. Cunningham BP, Brazina S, Morshed S, et al. Fracture healing: A review of clinical, imaging and laboratory diagnostic options. Injury, 2017, 48 Suppl 1: S69-S75.
12. Fisher JS, Kazam JJ, Fufa D, et al. Radiologic evaluation of fracture healing. Skeletal Radiol, 2019, 48(3): 349-361.
13. Balbachevsky D, Gomes PS, Credídio MV, et al. Intramedullary nail versus bridge plate in open tibial fractures-randomized clinical trial. Injury, 2021, 52(3): S77-S83.
14. 唐輝, 徐永清, 李春曉, 等. Ilizarov骨搬運技術結合病灶截骨治療Cierny-Mader Ⅳ型慢性脛骨骨髓炎. 中華創傷骨科雜志, 2018, 20(2): 105-111.
15. Lenze U, Pohlig F, Knebel C, et al. Autologous fibula transplantation for reconstruction of bone defects. Orthopade, 2017, 46(8): 648-655.
16. 亢哲, 鄧宇, 屈文強, 等. 誘導膜技術與Ilizarov骨搬運技術治療下肢長骨感染性骨缺損臨床療效的Meta分析. 生物骨科材料與臨床研究, 2020, 17(5): 25-31.
17. Morwood MP, Streufert BD, Bauer A, et al. Intramedullary nails yield superior results compared with plate fixation when using the Masquelet technique in the femur and tibia. J Orthop Trauma, 2019, 33(11): 547-552.
18. Mauffrey C, Hake ME, Chadayammuri V, et al. Reconstruction of long bone infections using the induced membrane technique: Tips and tricks. J Orthop Trauma, 2016, 30(6): e188-e193.

Chinese Journal of Reparative and Reconstructive Surgery

Flap combined with induced membrane technique in treatment of post-traumatic tibial osteomyelitis with soft tissue defect

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