TISSUE TRANSPLANTATION WITH BONE TRANSMISSION FOR TREATING LARGE DEFECTS OF TIBIAL BONE AND SOFT TISSUE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Huiren , WANG Lixin , ZHANG Yanmao , YU Zhanyong , LIU Zhiwang , LI Guohua , ZHAO Gang , HU Kejian.

No.3 Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P.R.China. Corresponding author: LIU Huiren, E-mail: ssklhr@163.com;

Corresponding author：

Keywords：

Tibial bone defect; Soft tissue defect of limb; Wound repair; Bone transmission

DOI：

10.7507/1002-1892.20130068

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Objective To investigate the effectiveness of tissue transplantation combined with bone transmission in treatment of large defects of tibial bone and soft tissue. Methods Between February 2006 and February 2011, 15 cases of traumatic tibia bone and soft tissue defects were treated. There were 12 males and 3 females, aged from 16 to 54 years (mean, 32 years). After internal and external fixations of fracture, 11 patients with open fracture (Gustilo type III) had skin necrosis, bone exposure, and infection; after open reduction and internal fixation, 2 patients with closed fracture had skin necrosis and infection; and after limb replantation, 2 patients had skin necrosis and bone exposure. The area of soft tissue defect ranged from 5 cm × 5 cm to 22 cm × 17 cm. Eight cases had limb shortening with an average of 3.5 cm (range, 2-5 cm) and angular deformity. The lenghth of bone defect ranged from 4 to 18 cm (mean, 8 cm). The flap transplantation and skin graft were used in 9 and 6 cases, respectively; bone transmission and limb lengthening orthomorphia were performed in all cases at 3 months after wound healing; of them, 2 cases received double osteotomy bone transmission, and 14 cases received autologous bone graft and reset after apposition of fracture ends. Results All flaps and skin grafts survived; the wound healed at 3.5 months on average (range, 3 weeks-18 months). The length of bone lengthening was 6-22 cm (mean, 8 cm). The time of bone healing and removal of external fixation was 9.5-39.0 months (mean, 15 months). The healing index was 40-65 days/cm (mean, 55 days/cm). All patients were followed up 1-5 years (mean, 4 years). The wounds of all the cases healed well without infection or ulceration. The functions of weight-bearing and walking were recovered; 6 cases had normal gait and 9 cases had claudication. The knee range of motion was 0° in extention, 120-160° in flexion (mean, 150°). According to the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system for ankle function, the results were excellent in 7 cases, good in 4 cases, and fair in 4 cases, with an excellent and good rate of 73.3%. Conclusion Tissue transplantation combined with bone transmission is an effective method to treat large defects of soft tissue and tibial bone, which can increase strength of bone connection and reduce damage to the donor site.

Citation： LIU Huiren,WANG Lixin,ZHANG Yanmao,YU Zhanyong,LIU Zhiwang,LI Guohua,ZHAO Gang,HU Kejian.. TISSUE TRANSPLANTATION WITH BONE TRANSMISSION FOR TREATING LARGE DEFECTS OF TIBIAL BONE AND SOFT TISSUE. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(3): 295-298. doi: 10.7507/1002-1892.20130068 Copy

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2.	安智全, 赵金忠, 曾炳芳. 加压延长与骨迁移修复胫骨长段骨缺损. 中国修复重建外科杂志, 2006, 20(8): 864-866.
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10.	王培吉, 董启榕, 秦建忠, 等. 吻合血管折叠式腓骨皮瓣修复大段胫骨及皮肤软组织缺损. 中华显微外科杂志, 2007, 30(4): 264-266.
11.	张永光, 王志强. 骨移植替代材料研究进展. 中国修复重建外科杂志, 2008, 22(10): 1264-1268.
12.	王志强, 宋会平, 邓华民, 等. 同种异体骨移植术后骨不连成因及治疗方法分析. 中国修复重建外科杂志, 2009, 23(5): 534-537.
13.	Mourikis A, Mankin HJ, Hornicek FJ, et al. Treatment of proximal humeral chondrosarcoma with resection and allograft. J Shoulder Elbow Surg, 2007, 16(5): 519-524.
14.	黄雷, 谢明, 王金辉, 等. 应用Orthofix重建外固定架治疗骨缺损. 中华创伤骨科杂志, 2004, 6(10): 1096-1101.
15.	艾合麦提·玉素甫, 陈统一, 王晓峰, 等. 应用Ilizarov技术治疗长管状骨缺损性骨不连. 中华骨科杂志, 2006, 26(4): 247-251.
16.	卢世璧, 王继芳, 王岩, 等主译. 坎贝尔骨科手术学. 10版. 济南: 山东科学技术出版社, 2005: 3175.
17.	刘亚平, 程国良, 潘达德, 等. 带血管腓骨移植的远期疗效报告. 中华骨科杂志, 2001, 21(1): 22-26.

1. 黄雷, 李兵, 刘沂, 等. 开放植骨治疗感染性骨折不愈合. 中华骨科杂志, 2005, 25(1): 30-34.
2. 安智全, 赵金忠, 曾炳芳. 加压延长与骨迁移修复胫骨长段骨缺损. 中国修复重建外科杂志, 2006, 20(8): 864-866.
3. 林立, 黄卫东, 徐基农, 等. 腓骨骨皮瓣移植修复肢体复合组织缺损. 中国修复重建外科杂志, 2005, 19(7): 533-535.
4. 许亚军, 寿奎水, 芮永军, 等. 以旋髂深动脉及肌皮穿支供血的髂骨皮瓣移植修复四肢复合组织缺损. 中华显微外科杂志, 2009, 32(5): 400-401.
5. 刘会仁, 李瑞国, 曹磊, 等. 旋股外侧动脉降支分叶肌皮瓣的设计与临床应用. 中华显微外科杂志, 2006, 29(1): 10-13.
6. 曾炳芳, 康庆林. 四肢骨不连外科学. 北京: 人民军医出版社, 2010: 146-147.
7. 刘会仁, 曹磊, 王立新, 等. 组织移植修复肢体严重损伤发生血管危象的原因分析. 中华显微外科杂志, 2010, 33(2): 161-162.
8. Hsieh CH, Yang CC, Kuo YR, et al. Free anterolateral thigh adipofascial perforator flap. Plast Reconsstr Surg, 2003, 112(4): 976-982.
9. 刘会仁, 李瑞国, 曹磊, 等. 股前外侧肌皮瓣在肢体组织缺损修复中的几点改进. 中华显微外科杂志, 2008, 31(6): 443-444.
10. 王培吉, 董启榕, 秦建忠, 等. 吻合血管折叠式腓骨皮瓣修复大段胫骨及皮肤软组织缺损. 中华显微外科杂志, 2007, 30(4): 264-266.
11. 张永光, 王志强. 骨移植替代材料研究进展. 中国修复重建外科杂志, 2008, 22(10): 1264-1268.
12. 王志强, 宋会平, 邓华民, 等. 同种异体骨移植术后骨不连成因及治疗方法分析. 中国修复重建外科杂志, 2009, 23(5): 534-537.
13. Mourikis A, Mankin HJ, Hornicek FJ, et al. Treatment of proximal humeral chondrosarcoma with resection and allograft. J Shoulder Elbow Surg, 2007, 16(5): 519-524.
14. 黄雷, 谢明, 王金辉, 等. 应用Orthofix重建外固定架治疗骨缺损. 中华创伤骨科杂志, 2004, 6(10): 1096-1101.
15. 艾合麦提·玉素甫, 陈统一, 王晓峰, 等. 应用Ilizarov技术治疗长管状骨缺损性骨不连. 中华骨科杂志, 2006, 26(4): 247-251.
16. 卢世璧, 王继芳, 王岩, 等主译. 坎贝尔骨科手术学. 10版. 济南: 山东科学技术出版社, 2005: 3175.
17. 刘亚平, 程国良, 潘达德, 等. 带血管腓骨移植的远期疗效报告. 中华骨科杂志, 2001, 21(1): 22-26.

Chinese Journal of Reparative and Reconstructive Surgery

TISSUE TRANSPLANTATION WITH BONE TRANSMISSION FOR TREATING LARGE DEFECTS OF TIBIAL BONE AND SOFT TISSUE

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