scholarly journals Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction: experience from 31 cases

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yong-Qing Xu ◽  
Xin-Yu Fan ◽  
Xiao-Qing He ◽  
Hong-Jie Wen
Keyword(s):  
Soft Tissue ◽  
External Fixation ◽  
Functional Results ◽  
Bone Transport ◽  
Fixation Index ◽  
Soft Tissue Defects ◽  
Safety And Efficacy ◽  
Tibial Bone ◽  
The Mean ◽  
Tissue Defects

Abstract Background Large post-traumatic tibial bone defects combined with soft tissue defects are a common orthopedic clinical problem associated with poor outcomes when treated using traditional surgical methods. The study was designed to investigate the safety and efficacy of trifocal bone transport (TFT) and soft-tissue transport with the Ilizarov technique for large posttraumatic tibial bone and soft tissue defects. Methods We retrospectively reviewed 31 patients with massive posttraumatic tibial bone and soft tissue defects from May 2009 to May 2016. All of the eligible patients were managed by TFT and soft-tissue transport. The median age was 33.4 years (range, 2–58 years). The mean defect of bone was 11.87 cm ± 2.78 cm (range, 8.2–18.2 cm) after radical resection performed by TFT. The soft tissue defects ranged from 7 cm × 8 cm to 24 cm × 12 cm. The observed results included bone union time, wound close time and true complications. The Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system was used to assess bone and functional results and postoperative complications were evaluated by Paley classification. Results The mean duration of follow-up after frame removal was 32 months (range, 12–96 months). All cases achieved complete union in both the elongation sites and the docking sites, and eradication of infection. The mean bone transport time was 94.04 ± 23.33 days (range, 63.7–147 days). The mean external fixation time was 22.74 ± 6.82 months (range, 14–37 months), and the mean external fixation index (EFI) was 1.91 ± 0.3 months/cm (range, 1.2–2.5 months/cm). The bone results were excellent in 6 patients, good in 14 patients, fair in 8 patients and poor in 3 patients. The functional results were excellent in 8 patients, good in 15 patients, fair in 5 patients and poor in 3 patients. Conclusion: TFT, in conjunction with soft tissue transport technique, can give good results in most patients (in this article, good and excellent results were observed in 64% of patients). Soft tissue transport is a feasible method in providing good soft tissue coverage on the bone ends. Although it has no advantages over microvascular techniques, it might be an good alternative in the absence of an experienced flap surgeon. Nonetheless, high-quality controlled studies are needed to assess its long-term safety and efficacy.

scholarly journals Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction: experience from 31 cases

2021 ◽  
Author(s):  
Yong-Qing Xu ◽  
Xin-Yu Fan ◽  
Xiao-Qing He ◽  
Hong Jie Wen
Keyword(s):  
Soft Tissue ◽  
External Fixation ◽  
Functional Results ◽  
Bone Transport ◽  
Fixation Index ◽  
Soft Tissue Defects ◽  
Safety And Efficacy ◽  
Tibial Bone ◽  
The Mean ◽  
Tissue Defects

Abstract Background Large post-traumatic tibial bone defects combined with soft tissue defects are a common orthopedic clinical problem associated with poor outcomes when treated using traditional surgical methods. The study was designed to investigate the safety and efficacy of trifocal bone transport (TFT) and soft-tissue transport with the Ilizarov technique for large posttraumatic tibial bone and soft tissue defects. Methods We retrospectively reviewed 31 patients with massive posttraumatic tibial bone and soft tissue defects from May 2009 to May 2016. All of the eligible patients were managed by TFT and soft-tissue transport. The median age was 33.4 years (range, 2-58 years). The mean defect of bone was 11.87cm ± 2.78cm (range, 8.2-18.2cm) after radical resection performed by TFT. The soft tissue defects ranged from 7cm x 8cm to 24cm x 12cm. The observed results included bone union time, wound close time and true complications. The Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system was used to assess bone and functional results and postoperative complications were evaluated by Paley classification. Results The mean duration of follow-up after frame removal was 32 months (range, 12-96 months). All cases achieved complete union in both the elongation sites and the docking sites, and eradication of infection. The mean bone transport time was 94.04 ± 23.33 days (range, 63.7-147 days). The mean external fixation time was 22.74 ± 6.82 months (range, 14-37 months), and the mean external fixation index (EFI) was 1.91 ± 0.3 months/cm (range, 1.2–2.5 months/cm). The bone results were excellent in 6 patients, good in 14 patients, fair in 8 patients and poor in 3 patients. The functional results were excellent in 8 patients, good in 15 patients, fair in 5 patients and poor in 3 patients. Conclusion: TFT, in conjunction with soft tissue transport technique, can give good results in most patients (in this article, good and excellent results were observed in 64% of patients). Soft tissue transport is a feasible method in providing good soft tissue coverage on the bone ends. Although it has no advantages over microvascular techniques, it might be an good alternative in the absence of an experienced flap surgeon. Nonetheless, high-quality controlled studies are needed to assess its long-term safety and efficacy.

scholarly journals Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction: experience from 31 cases

2020 ◽  
Author(s):  
Yong-Qing Xu ◽  
Xin-Yu Fan ◽  
Xiao-Qing He ◽  
Hong Jie Wen
Keyword(s):  
Soft Tissue ◽  
External Fixation ◽  
Functional Results ◽  
Bone Transport ◽  
Fixation Index ◽  
Soft Tissue Defects ◽  
Safety And Efficacy ◽  
Tibial Bone ◽  
The Mean ◽  
Tissue Defects

Abstract Background Large post-traumatic tibial bone defects combined with soft tissue defects are a common orthopedic clinical problem associated with poor outcomes when treated using traditional surgical methods. The study was designed to investigate the safety and efficacy of trifocal bone transport (TFT) and soft-tissue transport with the Ilizarov technique for large posttraumatic tibial bone and soft tissue defects. Methods We retrospectively reviewed 31 patients with massive posttraumatic tibial bone and soft tissue defects from May 2009 to May 2016. All of the eligible patients were managed by TFT and soft-tissue transport. The median age was 33.4 years (range, 2-58 years). The mean defect of bone was 11.87cm ± 2.78cm (range, 8.2-18.2cm) after radical resection performed by TFT. The soft tissue defects ranged from 7cm x 8cm to 24cm x 12cm. The observed results included bone union time, wound close time and true complications. The Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system was used to assess bone and functional results and postoperative complications were evaluated by Paley classification. Results The mean duration of follow-up after frame removal was 32 months (range, 12-96 months). All cases achieved complete union in both the elongation sites and the docking sites, and eradication of infection. The mean bone transport time was 94.04 ± 23.33 days (range, 63.7-147 days). The mean external fixation time was 22.74 ± 6.82 months (range, 14-37 months), and the mean external fixation index (EFI) was 1.91 ± 0.3 months/cm (range, 1.2–2.5 months/cm). The bone results were excellent in 6 patients, good in 14 patients, fair in 8 patients and poor in 3 patients. The functional results were excellent in 8 patients, good in 15 patients, fair in 5 patients and poor in 3 patients. Conclusion: TFT, in conjunction with soft tissue transport technique, can give good results in most patients (in this article, good and excellent results were observed in 64% of patients). Soft tissue transport is a feasible method in providing good soft tissue coverage on the bone ends. Although it has no advantages over microvascular techniques, it might be an good alternative in the absence of an experienced flap surgeon. Nonetheless, high-quality controlled studies are needed to assess its long-term safety and efficacy.

scholarly journals Reconstruction of massive tibial bone and soft-tissue defects by trifocal bone transport combined with soft-tissue transport: experience from 31 cases

2020 ◽  
Author(s):  
Yong-Qing Xu ◽  
Xin-Yu Fan ◽  
Xiao-Qing He ◽  
Hong Jie Wen
Keyword(s):  
Soft Tissue ◽  
External Fixation ◽  
Functional Results ◽  
Bone Transport ◽  
Fixation Index ◽  
Soft Tissue Coverage ◽  
Soft Tissue Defects ◽  
Tibial Bone ◽  
The Mean ◽  
Tissue Defects

Abstract Background The study was designed to investigate the safety and efficacy of trifocal bone transport (TFT) and soft-tissue transport with the Ilizarov technique for large posttraumatic tibial bone and soft tissue defects. Methods We retrospectively reviewed 31 patients with massive posttraumatic tibial bone and soft tissue defects from May 2009 to May 2016. All of the eligible patients were managed by TFT and soft-tissue transport. The median age was 33.4 years (range, 2-58 years). The mean defect of bone was 11.87cm ± 2.78cm (range, 8.2-18.2cm) after radical resection performed by TFT. The soft tissue defects ranged from 7cm x 8cm to 24cm x 12cm. The observed results included bone union time, wound close time and true complications. The Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system was used to assess bone and functional results and postoperative complications were evaluated by Paley classification. Results The mean duration of follow-up after frame removal was 32 months (range, 12-96 months). All cases achieved complete union in both the elongation sites and the docking sites, and eradication of infection. The mean bone transport time was 94.04 ± 23.33 days (range, 63.7-147 days). The mean external fixation time was 22.74 ± 6.82 months (range, 14-37 months), and the mean external fixation index (EFI) was 1.91 ± 0.3 months/cm (range, 1.2–2.5 months/cm). The bone results were excellent in 6 patients, good in 14 patients, fair in 8 patients and poor in 3 patients. The functional results were excellent in 8 patients, good in 15 patients, fair in 5 patients and poor in 3 patients. Conclusion The TFT in concert with soft-tissue transport technique can be used successfully to manage large tibial bone and soft-tissue defects. Soft-tissue transport can offer a feasible method for the defects with good soft tissue coverage on the bone ends. However, imprecision in the series results precludes a definitive conclusion, and comparative study is needed to assess whether soft-tissue transport is more effective than flap transfer for such soft-tissue defect.

scholarly journals Free flap transplantation combined with Ilizarov bone transport for the treatment of severe composite tibial and soft tissue defects

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110176
Author(s):  
Runguang Li ◽  
Canjun Zeng ◽  
Song Yuan ◽  
Yirong Chen ◽  
Shanwen Zhao ◽  
...  
Keyword(s):  
Soft Tissue ◽  
External Fixation ◽  
Clinical Efficacy ◽  
Free Flap ◽  
Bone Transport ◽  
Fixation Index ◽  
Functional Score ◽  
Soft Tissue Defects ◽  
Ilizarov Bone Transport ◽  
Tissue Defects

Objective To evaluate the clinical efficacy of free flap transplantation combined with Ilizarov bone transport in the treatment of severe composite tibial and soft tissue defects. Methods We retrospectively analyzed the clinical data of 40 patients with severe composite tibial and soft tissue defects who underwent free flap transplantation combined with Ilizarov bone transport. The clinical efficacy was evaluated according to the following criteria: success rate of wound repair by free flap transplantation, incidence or recurrence rate of deep infection, healing rate of bone defects and external fixation index, incidence of complications, and functional score of affected extremities. Results All infections were generally well controlled by radical debridement and negative-pressure therapy, and all 40 patients’ wounds healed after repair and reconstruction of the tibia and soft tissues. Postoperative complications were alleviated by active treatment. The mean external fixation time was 12.83 ± 2.85 months, and the external fixation index was 1.55 m/cm. According to the Association for the Study and Application of Methods of Ilizarov (ASAMI) score, an excellent or good functional outcome was attained in 85% of patients. Conclusion Free flap transplantation combined with Ilizarov bone transport is an effective treatment for severe composite tibial and soft tissue defects.

scholarly journals Bone Transport for Treatment of Traumatic Composite Tibial Bone and Soft Tissue Defects: Any Specific Needs besides the Ilizarov Technique?

2020 ◽  
Vol 2020 ◽  
pp. 1-13 ◽  
Author(s):  
Runguang Li ◽  
Guozheng Zhu ◽  
Chaojie Chen ◽  
Yirong Chen ◽  
Gaohong Ren
Keyword(s):  
Soft Tissue ◽  
Deep Infection ◽  
Bone Transport ◽  
Fixation Time ◽  
Ilizarov Technique ◽  
Soft Tissue Defects ◽  
Flap Surgery ◽  
Tibial Bone ◽  
Tissue Defects

Objective. To evaluate the surgical efficacy of bone transport (Ilizarov technique) plus “shortening-lengthening,” “flap surgery,” and “open bone transport” as individualized treatments for traumatic composite tibial bone and soft tissue defects. Methods. We retrospectively analyzed sixty-eight cases (mean age: 35.69 years, (range, 16–65)) treated from July 2014 to June 2017, including 29 middle, 18 distal, and 21 proximal tibial bone defects (4–18 cm, mean: 7.97 cm) with soft tissue defects (2.5 cm × 4.0 cm to 30.0 cm × 35.0 cm after debridement). We adopted the bone transport external fixator to fix the fracture after debriding the defect parts. In the meantime, we adopted the “shortening-lengthening technique,” “flap surgery,” and “open bone transport” as individualized treatment based on the location, range, and severity of the composite tibial bone and soft tissue defects. Postoperative follow-up was carried out. Surgical efficacy was assessed based on (1) wound healing; (2) bone defect healing rate; (3) external fixation time and index; (4) incidence/recurrence of deep infection; (5) postoperative complications; and (6) Association for the Study and Application of the Methods of Ilizarov (ASAMI) score. Results. The mean duration from injury to reconstruction was 22 days (4–80 d), and the mean postoperative follow-up period was 30.8 months (18–54 m). After the repair and reconstruction, 2 open bone transport patients required infected bone removal first before continuing the bone transport treatment. No deep infection (osteomyelitis) occurred or recurred in the remaining patients, and no secondary debridement was required. Some patients had complications after surgery. All the postoperative complications, including flap venous crisis, nail channel reaction, bone nonunion, mechanical axis deviation, and refracture, were improved or alleviated. External fixation time was 12.5 ± 3.41 months, and the index was 1.63 ± 0.44. According to the ASAMI score, 76.47% of the outcomes were good/excellent. Conclusion. The Ilizarov technique yields satisfactory efficacy for composite tibial bone and soft tissue defects when combined with “shortening-lengthening technique,” “flap surgery,” and “open bone transport” with appropriate individualized treatment strategies.

scholarly journals Correction to: Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction: experience from 31 cases

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yong-Qing Xu ◽  
Xin-Yu Fan ◽  
Xiao-Qing He ◽  
Hong-Jie Wen
Keyword(s):  
Soft Tissue ◽  
Bone Transport ◽  
Soft Tissue Defects ◽  
Tibial Bone ◽  
Tissue Defects

An amendment to this paper has been published and can be accessed via the original article.

scholarly journals Treatment of segmental tibial defects by bone transport with circular external fixation and a locking plate

2020 ◽  
Vol 48 (4) ◽  
pp. 030006052092040
Author(s):  
Yao Lu ◽  
Teng Ma ◽  
Cheng Ren ◽  
Zhong Li ◽  
Liang Sun ◽  
...  
Keyword(s):  
External Fixation ◽  
Locking Plate ◽  
Short Form ◽  
Clinical Results ◽  
Bone Transport ◽  
Fixation Index ◽  
Fixation Time ◽  
Sf 36 ◽  
Health Related ◽  
The Mean

Objective To evaluate the effectiveness of bone transport involving circular external fixation and locking plate application for the treatment of segmental tibial defects. Methods A retrospective review of 12 patients with segmental tibial defects who underwent bone transport with circular external fixation and locking plate application. We evaluated external fixation time, external fixation index, time to achieve union, and complications. Clinical results were assessed using the Association for the Study and Application of the Methods of Ilizarov (ASAMI) score. Generic health-related outcome was assessed using the 36-Item Short-Form Health Survey questionnaire (SF-36). Results The mean follow-up was 25.8 months, and the mean defect size was 6.7 cm. All of the patients achieved union at the distraction callus and docking site. The average external fixation time was 299.5 days. The mean external fixation index was 16.5 days/cm, and the mean healing index was 44.9 days/cm. The functional outcomes were excellent in eight cases and good in four. The average SF-36 score was 92. Conclusion Bone transport with external fixation and locking plate application may be a promising method for the treatment of segmental tibial defects.

scholarly journals Skin stretch suturing with Nice knots in the treatment of small- or medium-sized wounds

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jianmin Xu ◽  
Rui Chang ◽  
Wei Zhang ◽  
Chengcheng Zhang ◽  
Dezhi Zhu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hair Growth ◽  
Wound Closure ◽  
Skin Wound ◽  
Soft Tissue Defects ◽  
Cutaneous Sensation ◽  
The Mean ◽  
Skin Stretch ◽  
Mean Time ◽  
Tissue Defects

Abstract Background To investigate the clinical efficacy and outcomes of skin stretch suturing with self-locking sliding Nice knots in the treatment of small- or medium-sized wounds. Methods From June 2015 to May 2018, 26 patients with small- or medium-sized wounds were included in the present study. Skin stretch suturing with self-locking slide Nice knots was performed to gradually close the soft-tissue defects in these patients. The time of wound closure and healing was recorded. The color and blood supply of the skin, cutaneous sensation, the stretch of skin, and the hair growth situation of the skin wound were observed and recorded. Results There were 17 males and 9 females with an average age of 30.65 years (range, 15–48 years). The areas of the soft-tissue defects were between 3.2 × 7.1 cm and 8.0 × 15.2 cm. All patients underwent stretch suturing with self-locking slide Nice knots to close the soft-tissue defects. All wounds were successfully closed and healed. The mean time of wound closure was 10.69 days (range, 5–20 days), and the mean time of wound healing was 16.85 days (range, 10–24 days). The cutaneous sensation of skin wound recovered normally, and the color of the skin wounds was the same as that of normal skin at the last follow-up. The hair growth situation of the skin wounds also returned to normal. Conclusions This study revealed that Nice knots yielded an accepted clinical result as a new method to close small- or medium-sized wounds that was simple and less minimally invasive, resulted in progressive tension, did not return to previous results, and partially replace flaps or free skin grafts.

Reconstruction of Soft Tissue Defects and Bone Loss in the Tibia by Flap Transfer and Bone Transport by Distraction Osteogenesis

2020 ◽  
Vol 84 (5S) ◽  
pp. S202-S207 ◽  
Author(s):  
Abulaiti Abula ◽  
Maimaiaili Yushan ◽  
Peng Ren ◽  
Alimujiang Abulaiti ◽  
Chuang Ma ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Bone Loss ◽  
Distraction Osteogenesis ◽  
Bone Transport ◽  
Soft Tissue Defects ◽  
Flap Transfer ◽  
Tissue Defects
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