Modified Classification and Single-Stage Microsurgical Repair of Posttraumatic Infected Massive Bone Defects in Lower Extremities

Yun-fa Yang; Zhong-he Xu; Guang-ming Zhang; Jian-wei Wang; Si-wang Hu; Zhi-qi Hou; Da-chuan Xu

doi:10.1055/s-0033-1348064

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2013; 29(09): 593-600
DOI: 10.1055/s-0033-1348064

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Modified Classification and Single-Stage Microsurgical Repair of Posttraumatic Infected Massive Bone Defects in Lower Extremities

Authors

Yun-fa Yang

¹Institute of Clinical Anatomy, Southern Medical University, Guangzhou, Guangdong, People's Republic of China

²Division of Traumatic Orthopedics, Department of Orthopedic Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
Zhong-he Xu

²Division of Traumatic Orthopedics, Department of Orthopedic Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
Guang-ming Zhang

²Division of Traumatic Orthopedics, Department of Orthopedic Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
Jian-wei Wang

²Division of Traumatic Orthopedics, Department of Orthopedic Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
Si-wang Hu

¹Institute of Clinical Anatomy, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
Zhi-qi Hou

²Division of Traumatic Orthopedics, Department of Orthopedic Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
Da-chuan Xu

¹Institute of Clinical Anatomy, Southern Medical University, Guangzhou, Guangdong, People's Republic of China

Abstract

Posttraumatic infected massive bone defects in lower extremities are difficult to repair because they frequently exhibit massive bone and/or soft tissue defects, serious bone infection, and excessive scar proliferation. This study aimed to determine whether these defects could be classified and repaired at a single stage. A total of 51 cases of posttraumatic infected massive bone defect in lower extremity were included in this study. They were classified into four types on the basis of the conditions of the bone defects, soft tissue defects, and injured limb length, including Type A (without soft tissue defects), Type B (with soft tissue defects of 10 × 20 cm or less), Type C (with soft tissue defects of 10 × 20 cm or more), and Type D (with the limb shortening of 3 cm or more). Four types of single-stage microsurgical repair protocols were planned accordingly and implemented respectively. These protocols included the following: Protocol A, where vascularized fibular graft was implemented for Type A; Protocol B, where vascularized fibular osteoseptocutaneous graft was implemented for Type B; Protocol C, where vascularized fibular graft and anterior lateral thigh flap were used for Type C; and Protocol D, where limb lengthening and Protocols A, B, or C were used for Type D. There were 12, 33, 4, and 2 cases of Types A, B, C, and D, respectively, according to this classification. During the surgery, three cases of planned Protocol B had to be shifted into Protocol C; however, all microsurgical repairs were completed. With reference to Johner–Wruhs evaluation method, the total percentage of excellent and good results was 82.35% after 6 to 41 months of follow-up. It was concluded that posttraumatic massive bone defects could be accurately classified into four types on the basis of the conditions of bone defects, soft tissue coverage, and injured limb length, and successfully repaired with the single-stage repair protocols after thorough debridement.

Keywords

trauma - infection - massive bone defects - classification - repair

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Referenzen

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