Bone transport combined with open bone grafting and vacuum sealing drainage for treatment of infectious tibial bone defect

Abstract

Objective To assess the efficacy of using the Ilizarov bone transport combined with open bone grafting and vacuum sealing drainage (VSD) to treat infected tibial bone defect. Methods A retrospective case series study was made on 8 patients sustaining posttraumatic infectious tibial bone defect treated between March 2010 and May 2015. There were 7 male and 1 female patients between 22 and 51 years (mean, 39.4 years). All patients underwent radical resection of the infected/necrotic bone and debridement of the soft tissue. Length of bone defects after debridement averaged 8 cm (range, 3.5-13.5 cm) and wound size averaged 4.8 cm×2.5 cm (range, 2.3 cm×1.1 cm-8.5 cm×6.0 cm). Stabilization was finished with Ilizarov circular external frame in all patients. Six patients were candidates for single- or double-level bone transport, and the cancellous bone autograft was placed openly within the butterfly defect after docking. Other 2 patients were treated with one-stage shortening of the fracture ends and open cancellous bone grafting, and the bone lengthening was performed. Then the grafted wounds were covered by VSD. Data were recorded including the bone transport or lengthening time, wound healing time, union time of docking sites, consolidation time of regenerate zones, external fixation time and external fixation index. Bone results and functional results were evaluated according to the criteria given by association for the study and application of the method of Ilizarov (ASAMI). Results Duration of follow-up was 10.2-36.4 months (mean, 12.2 months). All the wounds achieved successful healing and eradication of infection. Mean bone transport time was 50 days (range, 30-69 days). Seven patients showed self-healing wounds, and mean healing time was 3.4 months (range, 1.2-6 months). One patient experienced wound closure by skin grafting. Union and consolidation were achieved in all docking sites and regenerate zones. Mean union time of docking sites after bone grafting was 6.8 months (range, 5.3-10 months). Mean consolidation time of regenerate zones was 6.2 months (range, 4.8-8.5 months). Mean external fixation time was 8.6 months (range, 6.5-11.5 months) with a mean external fixation index of 1.2 months/cm(range, 0.7-1.9 months/cm). According to the criterion of ASAMI, bony results were excellent in 7 patients and poor in 1 patient, and functional results were excellent in 4 patients and good in 4 patients. Conclusion Ilizarov bone transport technique combined with open bone grafting and VSD for infectious tibial bone defect can accelerate bone union and wound healing at docking sites and reduce external fixation time. Key words: Tibia; Osteomyelitis; Ilizarov technique; Fractures, ununited; Bone transplantation