Induced membrane technique and microsurgery for open leg fractures of Gustilo types IIIB-C

Abstract

Objective To evaluate the induced membrane technique combined with microsurgery for repair of open leg fractures of Gustilo types ⅢB-C. Methods This retrospective study reviewed 15 patients who had been treated for open leg fractures of Gustilo types ⅢB and ⅢC by the induced membrane technique and microsurgery between January 2015 and January 2017 at Institute of Orthopedics, 920 Hospital, The Joint Logistic Service of The People’s Liberation Army. They were 10 men and 5 women, aged from 18 to 41 years(average 32 years). There were 9 cases of Gustilo type IIIB and 6 ones of Gustilo type IIIC. After thorough debridement, the fractures were reduced and fixated temporarily using external frames. The bone defects were filled with antibiotic bone cement to induce biofilm formation. After necessary reconstruction of limb structures, including neurovascular repair and transposition of tendon and nerve, crucial soft-tissue wounds were covered with surgical flaps. In the secondary surgery 6 to 8 weeks later, with the external frames replaced by internal fixation or not, the bone cement was removed without damaging the biofilm before graft reconstruction with autogenous cancellous bone. Results The 15 legs were all salvaged successfully. The in-hospital time ranged from 21 to 39 days (mean, 29 days). Crucial wounds were repaired primarily without any severe or persistent infection. Follow-ups ranged from 12 to 24 months (average, 15 months). Bone union time ranged from 10 to 17 months (average, 11.2 months) with satisfactory aesthetic and functional recovery of the leg. Conclusion Reconstruction of open leg fractures of Gustilo types Ⅲ B-C with induced membrane technique and microsurgery can result in decreased therapeutic duration, reduced complications and positive outcomes. Key words: Fractures, open; Surgical flaps; Microsurgery; Leg; Induced membrane technique