Low Complication Rate Associated With Raising Mature Flap for Tibial Nonunion Reconstruction

Will, Ryan; Fleming, Mark E.; Lafferty, Paul M.; Fletcher, James; Cole, Peter A.

doi:10.1097/ta.0b013e3182282990

Cited by 3 publications

(4 citation statements)

References 19 publications

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“…In open fractures with wounds greater than 5 cm, the likelihood of delayed healing or nonunion was 5.7 times greater than that for closed fractures [8,9].…”

Section: Discussionmentioning

confidence: 85%

Compression - Distraction Osteogenesis With Ilizarov Apparatus in the Treatment of Tibial Non-Unions With Bone Defects

Sheshoski

Stojmenski

Atanasov

et al. 2021

JMS

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Treatment of the long bones defects and non-unions are among the most challenging cases to solve in the orthopaedic surgery. In these rare and difficult cases the method of compressiondistraction osteogenesis can be the only limb salvage procedure to promote healing of the bone with comprehensive approach to all aspects of the condition.Objective of this retrospective one centred study is to perform both radiological and functional evaluation of the treatment of tibial non-unions with segmental bone defects or significant axial deviation using the method of compression -distraction osteogenesis with the Ilizarov apparatus. In the period between 2006 and 2018 15 patients were surgically treated using this method (in 9 of them as an intercalary bone transport and in other 6 as a continuous distraction with correction of axial deviation). There was an average of 22.9 months from injury and all of them underwent previous surgeries with an average of 2.3/patient. ASAMI (Association for studying and application of Ilizarov methods) scoring system was used for both radiological (bone) and functional results. Also patient's satisfaction with the achieved results was ranked postoperatively. 80% of the patients achieved satisfactory (good and excellent) bone results and 73% satisfactory functional results. Approximately 87% of the patients were personally satisfied with the achieved results.The method of compression -distraction osteogenesis using Ilizarov apparatus proved to be effective as a limb salvage procedure with high degree of excellent and good both radiological and functional results.

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“…In open fractures with wounds greater than 5 cm, the likelihood of delayed healing or nonunion was 5.7 times greater than that for closed fractures [8,9].…”

Section: Discussionmentioning

confidence: 85%

Compression - Distraction Osteogenesis With Ilizarov Apparatus in the Treatment of Tibial Non-Unions With Bone Defects

Sheshoski

Stojmenski

Atanasov

et al. 2021

JMS

View full text Add to dashboard Cite

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“…In open fractures with skin wound bigger than 5cm the probability for these complication was 5.7 times higher compared to closed fractures. [6,7] Usually the open fractures are the ones prone to complications like infections, delayed or non-unions and with all that are burdens not only for the individuals but for the whole healthcare system.…”

Section: Introductionmentioning

confidence: 99%

COMPARISON OF THE VALUES OF EFT (External Fixation Time) IN THE TREATMENT OF LOWER LEG OPEN FRACTURES AND NON-UNIONS WITH THE METHOD OF COMPRESSION-DISTRACTION OSTEOSYNTHESIS BY ILIZAROV

Sheshoski,

Stojmenski,

Atanasov

et al. 2023

JMS

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Open tibial fractures rank among the most common injuries to long bones, with an annual incidence of 3.4 per 100,000. Complications such as non-unions may arise in 2-10% of these injuries. The Ilizarov method offers a universal opportunity for definitive treatment in both conditions.This retrospective unicentric cohort study aims to assess the value of External Fixation Time (EFT) in patients with open tibial fractures and non-unions treated with compression-distraction osteosynthesis by Ilizarov, followed by a comparative analysis.We evaluated 30 patients treated between 2014 and 2019 for open fractures or non-union of the tibia. The average ages for the two groups were 46 and 50 years, respectively. The latter group had an average of 1.6 prior surgical treatments, with approximately 14 months elapsed since the injury. All subjects examined achieved bone healing. The average EFT values were 160 and 210 days for the treatment of open fractures and non-unions, respectively. There is a statistically significant difference in the EFT values between both groups. 97% of the patients demonstrated satisfactory radiographic results based on the ASAMI scoring system.Treatment with compression-distraction osteosynthesis by Ilizarov proved effective for both open fractures and non-unions of the lower leg. A statistically significant difference exists between the two groups in terms of EFT values representing the duration of treatment.

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“…6,[9][10][11] Although previous literature suggests delayed bone grafting until full wound epithelialization with cessation of drainage, 10 similar rates of nonunion between muscle and free flaps, 9,12,13 preference of timing of secondary flap elevation at 3 months after inset, 14 and employment of an integrative orthoplastic strategy for complex limb reconstruction, 15 limited guidance exists on the ideal surgical approach for secondary procedures, specifically for secondary bone grafting. 16,17 As postoperative complications after flap inset are significantly associated with secondary amputation, evaluation of com-plications associated with approach is critical to limb salvage planning. 18 The primary aim of this study was to evaluate complications comparing surgical approaches for secondary bone grafting in patients who had previously undergone soft tissue reconstruction after open tibia fractures.…”

mentioning

confidence: 99%

“…No subsequent complications were reported and the patient healed uneventfully after this revision.Previous research has demonstrated flap elevation for secondary procedures can be safe. Will et al17 reported flap elevation for nonunion surgery in 24 patients who had previously underwent soft tissue reconstruction for type IIIB open tibia fractures. The authors reported a flap survival rate of 96% after one flap in their series failed reelevation.…”

mentioning

confidence: 99%

Secondary Bony Defects after Soft Tissue Reconstruction in Limb-Threatening Lower Extremity Injuries: Does the Approach to Flap Elevation Matter?

Burke

Mundy

Gupta

et al. 2023

J Reconstr Microsurg

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Background Limb-threatening lower extremity injuries often require secondary bone grafting after soft tissue reconstruction. We hypothesized that there would be fewer wound complications when performing secondary bone grafting via a remote surgical approach rather than direct flap elevation. Methods A retrospective cohort study was performed at a single Level 1 trauma center comparing complications after secondary bone grafting in patients who had undergone previous soft tissue reconstruction after open tibia fractures between 2006 and 2020. Comparing bone grafting via a remote surgical incision versus direct flap elevation, we evaluated wound dehiscence requiring return to the operating room as the primary outcome. Secondary outcomes were deep infection and delayed amputation. Results We identified 129 patients (mean age: 40 years, 82% male) with 159 secondary bone grafting procedures. Secondary bone grafting was performed via a remote surgical approach in 54% (n = 86) and direct flap elevation in 46% (n = 73) of cases. Wound dehiscence requiring return to the operating room occurred in one patient in the flap elevation group (1%) and none of the patients in the remote surgical approach. The odds of deep wound infection (OR, 1.77; p = 0.31) or amputation (OR, 1.43; p = 0.73) did not significantly differ between surgical approaches. No significant differences were found in complications between the reconstructive surgeon elevating and re-insetting the flap and the orthopaedic trauma surgeon performing the flap elevation and re-inset. Conclusion Direct flap elevation for secondary bone grafting after soft tissue reconstruction for open tibia fractures did not result in more complications than bone grafting via a remote surgical approach. These findings should reassure surgeons to allow other clinical factors to influence the surgical approach for bone grafting.

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Low Complication Rate Associated With Raising Mature Flap for Tibial Nonunion Reconstruction

Cited by 3 publications

References 19 publications

Compression - Distraction Osteogenesis With Ilizarov Apparatus in the Treatment of Tibial Non-Unions With Bone Defects

Compression - Distraction Osteogenesis With Ilizarov Apparatus in the Treatment of Tibial Non-Unions With Bone Defects

COMPARISON OF THE VALUES OF EFT (External Fixation Time) IN THE TREATMENT OF LOWER LEG OPEN FRACTURES AND NON-UNIONS WITH THE METHOD OF COMPRESSION-DISTRACTION OSTEOSYNTHESIS BY ILIZAROV

Secondary Bony Defects after Soft Tissue Reconstruction in Limb-Threatening Lower Extremity Injuries: Does the Approach to Flap Elevation Matter?

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