Defects of crural composite tissues treated by acute angular shortening and delayed distraction histogenesis with an external fixator

Abstract

Objective To evaluate the efficacy of acute angular shortening and delayed distraction histogenesis with an external fixator in the treatment of crural composite tissue defects. Methods From May 2009 to August 2014, 6 patients with crural composite tissue defects were treated by acute angular shortening and delayed gradual distraction histiogenesis with an external fixator. They were 5 men and one woman, from 23 to 65 years of age (average, 38.8 years). According to the Gustilo classification, 2 cases were graded as type Ⅲ A and 4 as type ⅢB. Four of them received primary treatment at our department while the other 2 were transferred to our hospital after primary management in other hospitals. Radical debridement was rapidly performed once life threatening factors were eliminated. The lower limbs were maximally bended to close the skin defects. The wounds were closed directly in 4 cases; the remnant wounds in the other 2 cases were cured by daily dressing in one and covered by skin graft in the other. Next, about 2 to 3 weeks after complete wound healing the pre-constructed circular fixators were mounted to the bended cms before they were adjusted to correct angulation deformity and reconstruct bone defects. Results All the wounds in the 6 cases healed successfully without additional microsurgical transfer of osteocutaneous flap. The regenerative skin tissue was similar to the skin in situ. The follow-ups ranged from 8 to 24 months (mean, 16.8 months). The average length of lengthened tibia was 8.0 cm and the time for Ilizarov external fixation ranged from 10 to 25 months (mean, 17.3 months). The average bone lengthening index was 2.3 months/cm. The limb functional recovery was rated as excellent in 2 cases and good in 4. The radiography revealed complete reconstruction of bone defects and restoration of mechanical alignments in all the cases. No disability was recorded during follow-up. Conclusions Acute angular shortening and delayed distraction histogenesis with an external fixator is a very effective treatment of crural bone and soft tissue defects. It can provide rapid management of acute or subacute open injury because it does not necessitate microsurgical flap transfer or bone graft, thus avoiding donor site morbidity. Key words: Fractures, open; External fixators; Bone lengthening; Ilizarov technique