Flap combined with induced membrane technique in treatment of post-traumatic tibial osteomyelitis with soft tissue defect_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

FAN Jinzhu , CONG Fei , REN Xiaoyu , ZHANG Ke ,  SONG Tao

Department of Bone Microsurgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P. R. China;

Corresponding author：

SONG Tao, Email: st0325@126.com

Keywords：

Tibial osteomyelitis; flap; induced membrane technique; bone defect; wound repair

DOI：

10.7507/1002-1892.202201031

Video：

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Objective To investigate the effectiveness of flap combined with induced membrane technique in treatment of post-traumatic tibial osteomyelitis with soft tissue defect. Methods A clinical data of 33 patients with post-traumatic tibial osteomyelitis with soft tissue defect who met the selection criteria between August 2015 and October 2018 was retrospectively analyzed. There were 21 males and 12 females. The age ranged from 19 to 70 years, with an average of 39 years. The osteomyelitis located in the upper 1/3 of tibia in 8 cases, in the middle 1/3 of tibia in 14 cases, and in the lower 1/3 of tibia in 11 cases. According to Cierny-Mader classification standard, 19 cases of osteomyelitis were type Ⅲ and 14 cases were type Ⅳ. The duration of osteomyelitis ranged from 2 months to 20 years (median, 3 months). In the first-stage operation, after radical debridement, the length of bone defect was 1.5-12.5 cm (mean, 5.0 cm) and the size of soft tissue defects ranged from 5 cm×4 cm to 15 cm×12 cm. Bone cement containing antibiotics was implanted into the bone defect and the personalized flap was used to repair the wound. After the wound healed at 6-8 weeks and the infection was controlled, bone grafting was performed to repair bone defects in the second-stage operation. Results The flaps survived completely after the first-stage operation in 29 cases. Partial necrosis of the flap occurred in 4 cases and healed after surgical dressing change. All the incisions healed by first intention after the second-stage operation. All patients were followed up 24-32 months (mean, 28 months). All the bone grafts healed after operation, and the radiographic healing time was 3-9 months (mean, 5 months). The clinical healing time was 4-14 months (mean, 8 months). There was no recurrence of osteomyelitis during follow-up. At last follow-up, according to Johner-Wruhs evaluation criteria, the limb function was excellent in 27 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 93.9%. Conclusion For the post-traumatic tibial osteomyelitis with soft tissue defect, the flap combined with induced membrane technique is a reliable and effective method and can effectively restore the function of lower limbs with satisfactory effectiveness.

Citation： FAN Jinzhu, CONG Fei, REN Xiaoyu, ZHANG Ke, SONG Tao. Flap combined with induced membrane technique in treatment of post-traumatic tibial osteomyelitis with soft tissue defect. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(5): 614-618. doi: 10.7507/1002-1892.202201031 Copy

1.	任义军, 胡锐, 严立, 等. 组织移植结合Ilizarov骨牵张技术重建下肢骨与软组织缺损. 中华显微外科杂志, 2020, 43(3): 233-237.
2.	鲍丙波, 魏海峰, 宋家林, 等. 分期手术治疗小腿Gustilo-Anderson ⅢC型骨折的疗效. 中华创伤杂志, 2021, 37(5): 395-401.
3.	汤不器, 朱威宏. 创伤后骨髓炎的诊治进展. 中南大学学报(医学版), 2021, 46(11): 1290-1297.
4.	Careri S, Vitiello R, Oliva MS, et al. Masquelet technique and osteomyelitis: innovations and literature review. Eur Rev Med Pharmacol Sci, 2019, 23(2 Suppl): 210-216.
5.	石健, 杨晓勇, 陈星宇, 等. 膜诱导技术结合内固定分期治疗股骨感染性骨不连. 中华创伤杂志, 2021, 37(6): 555-561.
6.	Viale GJ, Garabano G, Pesciallo C, et al. Structural allograft and induced membrane technique for treatment of 10-cm segmental femoral bone defect: A case report. JBJS Case Connect, 2021, 11(4): e21.00372. doi: 10.2106/JBJS.CC.21.00372.
7.	吴斗, 刘强. Masquelet技术修复骨缺损的实验研究现状和展望. 中华实验外科杂志, 2020, 37(11): 1983-1987.
8.	谢利军, 李杭, 潘志军, 等. Masquelet诱导膜技术修复胫骨感染性缺损. 中华创伤骨科杂志, 2018, 20(10): 860-865.
9.	王俊杰, 娄朝晖. 降钙素原、D-二聚体、C反应蛋白、血沉、血常规在创伤骨科患者围手术期治疗中的临床意义. 中外医疗, 2020, 39(15): 47-49.
10.	Arshad Z, Lau EJ, Aslam A, et al. Management of chronic osteomyelitis of the femur and tibia: a scoping review. EFORT Open Rev, 2021, 6(9): 704-715.
11.	Cunningham BP, Brazina S, Morshed S, et al. Fracture healing: A review of clinical, imaging and laboratory diagnostic options. Injury, 2017, 48 Suppl 1: S69-S75.
12.	Fisher JS, Kazam JJ, Fufa D, et al. Radiologic evaluation of fracture healing. Skeletal Radiol, 2019, 48(3): 349-361.
13.	Balbachevsky D, Gomes PS, Credídio MV, et al. Intramedullary nail versus bridge plate in open tibial fractures-randomized clinical trial. Injury, 2021, 52(3): S77-S83.
14.	唐辉, 徐永清, 李春晓, 等. Ilizarov骨搬运技术结合病灶截骨治疗Cierny-Mader Ⅳ型慢性胫骨骨髓炎. 中华创伤骨科杂志, 2018, 20(2): 105-111.
15.	Lenze U, Pohlig F, Knebel C, et al. Autologous fibula transplantation for reconstruction of bone defects. Orthopade, 2017, 46(8): 648-655.
16.	亢哲, 邓宇, 屈文强, 等. 诱导膜技术与Ilizarov骨搬运技术治疗下肢长骨感染性骨缺损临床疗效的Meta分析. 生物骨科材料与临床研究, 2020, 17(5): 25-31.
17.	Morwood MP, Streufert BD, Bauer A, et al. Intramedullary nails yield superior results compared with plate fixation when using the Masquelet technique in the femur and tibia. J Orthop Trauma, 2019, 33(11): 547-552.
18.	Mauffrey C, Hake ME, Chadayammuri V, et al. Reconstruction of long bone infections using the induced membrane technique: Tips and tricks. J Orthop Trauma, 2016, 30(6): e188-e193.

1. 任义军, 胡锐, 严立, 等. 组织移植结合Ilizarov骨牵张技术重建下肢骨与软组织缺损. 中华显微外科杂志, 2020, 43(3): 233-237.
2. 鲍丙波, 魏海峰, 宋家林, 等. 分期手术治疗小腿Gustilo-Anderson ⅢC型骨折的疗效. 中华创伤杂志, 2021, 37(5): 395-401.
3. 汤不器, 朱威宏. 创伤后骨髓炎的诊治进展. 中南大学学报(医学版), 2021, 46(11): 1290-1297.
4. Careri S, Vitiello R, Oliva MS, et al. Masquelet technique and osteomyelitis: innovations and literature review. Eur Rev Med Pharmacol Sci, 2019, 23(2 Suppl): 210-216.
5. 石健, 杨晓勇, 陈星宇, 等. 膜诱导技术结合内固定分期治疗股骨感染性骨不连. 中华创伤杂志, 2021, 37(6): 555-561.
6. Viale GJ, Garabano G, Pesciallo C, et al. Structural allograft and induced membrane technique for treatment of 10-cm segmental femoral bone defect: A case report. JBJS Case Connect, 2021, 11(4): e21.00372. doi: 10.2106/JBJS.CC.21.00372.
7. 吴斗, 刘强. Masquelet技术修复骨缺损的实验研究现状和展望. 中华实验外科杂志, 2020, 37(11): 1983-1987.
8. 谢利军, 李杭, 潘志军, 等. Masquelet诱导膜技术修复胫骨感染性缺损. 中华创伤骨科杂志, 2018, 20(10): 860-865.
9. 王俊杰, 娄朝晖. 降钙素原、D-二聚体、C反应蛋白、血沉、血常规在创伤骨科患者围手术期治疗中的临床意义. 中外医疗, 2020, 39(15): 47-49.
10. Arshad Z, Lau EJ, Aslam A, et al. Management of chronic osteomyelitis of the femur and tibia: a scoping review. EFORT Open Rev, 2021, 6(9): 704-715.
11. Cunningham BP, Brazina S, Morshed S, et al. Fracture healing: A review of clinical, imaging and laboratory diagnostic options. Injury, 2017, 48 Suppl 1: S69-S75.
12. Fisher JS, Kazam JJ, Fufa D, et al. Radiologic evaluation of fracture healing. Skeletal Radiol, 2019, 48(3): 349-361.
13. Balbachevsky D, Gomes PS, Credídio MV, et al. Intramedullary nail versus bridge plate in open tibial fractures-randomized clinical trial. Injury, 2021, 52(3): S77-S83.
14. 唐辉, 徐永清, 李春晓, 等. Ilizarov骨搬运技术结合病灶截骨治疗Cierny-Mader Ⅳ型慢性胫骨骨髓炎. 中华创伤骨科杂志, 2018, 20(2): 105-111.
15. Lenze U, Pohlig F, Knebel C, et al. Autologous fibula transplantation for reconstruction of bone defects. Orthopade, 2017, 46(8): 648-655.
16. 亢哲, 邓宇, 屈文强, 等. 诱导膜技术与Ilizarov骨搬运技术治疗下肢长骨感染性骨缺损临床疗效的Meta分析. 生物骨科材料与临床研究, 2020, 17(5): 25-31.
17. Morwood MP, Streufert BD, Bauer A, et al. Intramedullary nails yield superior results compared with plate fixation when using the Masquelet technique in the femur and tibia. J Orthop Trauma, 2019, 33(11): 547-552.
18. Mauffrey C, Hake ME, Chadayammuri V, et al. Reconstruction of long bone infections using the induced membrane technique: Tips and tricks. J Orthop Trauma, 2016, 30(6): e188-e193.

Chinese Journal of Reparative and Reconstructive Surgery

Flap combined with induced membrane technique in treatment of post-traumatic tibial osteomyelitis with soft tissue defect

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