Free flap transfer combined with the Ilizarov technique for type IIIB and IIIC open fracture of extremities: Experience with 8 cases

Abstract

Severe open fractures of the limbs caused by high-energy events are common. Orthopaedic surgeons are often confused when making treatment protocols for these injuries. A case series of 8 patients with type IIIB and IIIC open fractures of the extremities managed with free tissue transfer combined with the Ilizarov technique is presented. This is a retrospective study of 8 patients with Gustilo type IIIB and IIIC open fractures of the extremities treated with free tissue transfer and the Ilizarov technique. The bone and functional outcomes were evaluated using the Association for the Study and Application of the Method of Ilizarov (ASAMI) classification, and the complications were classified according to the Paley criteria. The mean follow-up duration was 22.5 ​± ​6.85 months (range, 13–36 months). All patients achieved complete union in both soft tissue and bone defects. The limb length of the 8 patients was completely restored. The mean bone defect was 9.4 ​± ​2.0 ​cm (range, 6.5–13.3 ​cm). The mean bone union time was 11.1 ​± ​2.3 months (range, 7.0–15.0 months). The mean bone transport time was 113.9 ​± ​17.7 days (range, 87–136 days). The mean soft tissue defect was 109.5 ​± ​78.8 ​cm2 (range, 98–299 ​cm2). The mean healing time of the soft tissue defects was 2.5 ​± ​2.3 months (range, 1.0–8.0 months). The mean external fixation time was 17.1 ​± ​3.48 months (range, 10–21 months), and the mean external fixation index (EFI) was 2.1 ​± ​0.7 ​months/cm (range, 1.1–3.5 ​months/cm). The bone outcomes were excellent in five patients, good in two patients, and fair in one patient. The functional outcomes were excellent in three patients, good in three patients, and fair in two patients. There were five problems, 13 obstacles, and one true complication according to the Paley criteria. Performing free tissue transfer combined with the Ilizarov technique in patients with Gustilo type IIIB and IIIC open fractures of the extremities is safe and effective. Our data suggest performing free tissue transfer combined with the Ilizarov technique in patients with Gustilo type IIIB and IIIC open fractures of the extremities is safe and effective.