[Ilizarov technique combined with segmented removal of bone cement for the treatment of composite defects of tibia and soft tissues of skin].

OBJECTIVE

To explore clinical efficacy of Ilizarov technique combined with the segmented removal of bone cement in treating tibial and skin-soft tissue composite defects.

METHODS

From July 2018 to December 2021, 9 patients with composite defects of tibia and skin and soft tissue of the lower leg were treated by Ilizarov technique combined with segmented removal of bone cement, including 7 males and 2 females, aged from 38 to 52 years old, 4 patients on the left side and 5 patients on the right side;the length of bone defect ranged from 8.0 to 12.0 cm;the wound area ranged from 4.0 cm×5.0 cm to 6.0 cm×10.0 cm. After the infection lesion in the lower leg has been cleared and the infection has been controlled by bone cement filling for 6 to 8 weeks, the bone cement was removed after tibial osteotomy. Then, new bone cement was made and divided into several small sections to fill the bone defect area, leaving a sliding gap. Bone slippage began at 10 days after operation (1 mm/d, performed in 6 sessions). As the slippage progressed, the bone cement segments were removed successively until the connection points were successfully connected and the wound healed. The locking was completed, the mineralization of the sliding gap and bone healing at the docking point were evaluated based on X-ray films from 3 to 6(monthly), 9 and 12 months. The clinical efficacy was evaluated by Paley criteria at 2 years after operation.

RESULTS

All 9 patients were followed up for 17 to 30 months. There were no soft tissue collapse or entrapment, and no complications such as infection recurrence occurred on the wound surface during bone segment sliding process. Eight patients achieved successful bony union at the junction, 1 patient achieved bony union after bone grafting at the junction, 6 patients had successful wound healing, and 3 patients underwent surgical adjustment due to indentations of skin margin at the junction, which affected the appearance. All the wounds achieved primary healing after operation. Two years after operation, the therapeutic effect was evaluated according to Paley standard, 7 patients got excellent results and 2 good.

CONCLUSION

Ilizarov technique combined with segmented removal of bone cement could simultaneously address composite defects of tibia and skin soft tissue of the lower leg, reducing flap surgery and avoiding complications such as soft tissue collapse and entrapation during bone segment sliding.