Bone composite with autologous red bone marrow and wrapped by a pedicle fascial flap for treatment of bone defects after limb wound with low toxicity infection

Abstract

Objective To study the effect of implantation of bone composite with autologous red bone marrow (ARBM) and wrapped by a pedicle fascial flap following debridement of infection focus in the treatment of bone defect after limb wound with low toxicity infection in comparison with implantation of bone composite only with ARBM. Methods From January of 2006 to April of 2011,42 patients with limb wound with low toxicity infection were randomized into Group A and Group B.In Group A (20 cases),ARBM bone composite containing bone morphogenetic protein (BMP) and osteoinductive absorbing material (OAM) was implanted after debridenent of infection focus; in Group B (22 cases),a pedicle fascial flap was prepared close to the bone defect to wrap the same bone composite as used in Group A before it was implanted.The 2 groups were comparable in general clinical data ( P ≥ 0.05). Histological and bacteriological tests were conducted for necessary cases. Blood routine,blood sedimentation,C-reactive protein,X-ray evaluation and fracture healing time were compared between the 2 groups at the 3rd,6th,12th and 18th months postoperation. Results The 42 patients were followed up for 14.3 months on average. Inflammatory sinus tract and inflammatory secretion,occurring in 5 cases in Group A and one case in Group B,were treated secondarily 10 months postoperation by infection focus debridement before implantation of ARBM bone composite wrapped by a pedicle fascial flap.The follow-up at 12 months showed fine outcomes.The wounds healed well and there was no sinus tract in the other cases in the 2 groups.The histological examinations showed 5 cases in Group A had still fibrous connective tissue between the previous broken bone ends,an obstructed medullary canal and inflammatory cell infiltration while 6 cases in Group B had periosteum-like tissue forming from the previous pedicle fascial flap,a little cartilage scattered in the new bone,an unobstructed medullary cavity,no inflammatory cell infiltration,and negative results of bacterial examination.At all time points,Group B was significantly superior to Group A in terms of blood routine,blood sedimentation,C-reactive protein,X-ray quantization score of osteoanagenesis and bone healing time at different parts ( P ＜ 0.05 ). Conclusion Compared with simple ARBM bone composite for the treatment of bone defect after limb wound with low toxicity infection,ARBM bone composite wrapped by a pedicle fascial flap is more effective in anti-infection and in reducing the bone healing time as well after it is implanted in the cleared infection focus. Key words: Bone; Wounds and injuries; Bone marrow; Surgical procedures, operative