Clinical study on the repairing of Gustilo III B and III C open tibia fractures by bone fixation and tissue flap

Abstract

Objective To investigate the choice of methods and time on the treatment of Gustilo type 11I B and type m c open tibia fractures by bone fixation and tissue flap repairing. Methods The clinic data of 156 cases of Gustilo Ⅲ B and ⅢC open tibia fractures were retrospectively studied. There were 102 males and 34 females, with average age of 34 years（range 14 to 68 years）. Ninety-eight cases were classified as Gustilo type ⅢB and 38 cases were type Ⅲ C in degree. In all cases, one hundred and thirteen were treated with one- stage external fixation, ninteen cases were treated with secondary bone fixation. Sixty-seven cases of all wounds were repaired by one-stage vascular pedicle skin flap. Seven wounds were repaired by one-stage free flaps with vascular anastomosis. Sixty-two cases were secondary repaired by different flaps after defect tissue under VSD （vacuum-sealing-drainage） treatment by 1 to several weeks, which contains 9 free skin graft, eleven muscle flaps based on posterior tibial artery perforator, thirteen flaps based on fibial artery perforator, fourteen gastroc- nemius falps and 15 cross-leg flaps. Results Wound of all cases were healed wholly. Primary union oc- curred in 121 cases, twelve vases healed after bone grafting for segmental bone defect. Three cases with delayed union healed after reoperation for infection that caused osteomyelitis and sinus tract. The period of bone healing was form 5 to 12 months. Conclusion The treatment of Gustilo Ⅲ B and Ⅲ C open tibia fractures by one- stage or secondary bone fixation and tissue flap repairing get their advantages and disadvantages, but one-stage bone fixation and tissue flap repairing was better where appropriate. Key words: Tibia frartures ; Gustilo type; Bone fixation; Tissue flap