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An alternative therapeutic strategy for infected large bone defect and massive soft-tissue loss of leg—is free flap reconstruction inevitable?

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Abstract

Purpose

This study aims to report the clinical and radiographic outcomes of a non-flap therapeutic strategy for the limb salvage of infected composite bone and soft-tissue defects of a leg, attempting to describe some new techniques regards the docking of bone ends.

Methods

Twelve patients with infected large tibial bone defect (mean size 12.1 ± 2.8 cm) and massive soft-tissue loss (mean size 254.5 ± 60.2 cm2) who were treated with the non-flap therapeutic strategy between 2014 and 2019 were retrospectively reviewed. Clinical and radiographic results were evaluated and analyzed. The results of bone and function were assessed by the Paley criteria. The exercise capacity of patients was evaluated based on the following four aspects: walking, running, jum**, squatting, and going up/down the stairs.

Results

During the treatment, shortening and re-lengthening technique was applied in six patients, bone transport technique in 12, submarine technique (SMT) in six, balloon dilatation technique (BDT) in seven, and soft-tissue incarceration creating technique (SICT) in seven. The mean external fixation time (EFT) and external fixation index (EFI) were 675.6 ± 179.2 days (range, 366–1040 days) and 60.1 ± 13.9 days/cm (range, 47.0–95.5 days/cm), respectively. Soft-tissue defect was successfully repaired for all patients. After a mean follow-up of 43.5 ± 23.2 months (range, 13–103 months), bone result was classified as “excellent” in ten patients, as “good” in one and “poor” in one, while functional result was graded as “excellent” in four patients and “good” in eight.

Conclusions

The non-flap therapeutic strategy could be cautiously considered as an alternative treatment for the large lower limb composite defects.

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Data availability

The data used or analyzed in this study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Acknowledgements

The authors thank **a Tang, RN, and Li Yang, MD, for measuring the data of defects, and Longmei Zhao, PhD, **uzhen Zhang, PhD, and Yuting Song, MD, for painting illustrations and for their support and encouraging during this research.

Funding

This study was supported by the Key Research and Development Project of Tibet.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Avenue, Chengdu, 610041, Sichuan Province, China

    Yaxing Li, Yu Chen, Tingjiang Gan, Boquan Qin, ** Liu & Hui Zhang

  2. Disaster Medicine Center, Sichuan University, Chengdu, 610041, Sichuan Province, China

    Yaxing Li & Hui Zhang

Authors
  1. Yaxing Li
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  2. Yu Chen
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  3. Tingjiang Gan
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  4. Boquan Qin
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  5. ** Liu
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  6. Hui Zhang
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Contributions

Yaxing Li: Designing the study, analyzing and interpreting the data, drafting the manuscript.

Yu Chen: Analyzing and interpreting the data, drafting the manuscript.

Tingjiang Gan: Analyzing and interpreting the data, drafting the manuscript.

Boquan Qin: Collecting and interpreting the data.

** Liu: Collecting the data, critically revising the manuscript.

Hui Zhang: Designing the study, acquiring the data, critically revising the manuscript.

Corresponding author

Correspondence to Hui Zhang.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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All patients included in this study agree to participate in this study.

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Each author confirms that this manuscript has not been published elsewhere and is not under consideration by another journal. All authors have approved the manuscript and agree with submission to International Orthopaedics.

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The authors declare no competing interests.

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Li, Y., Chen, Y., Gan, T. et al. An alternative therapeutic strategy for infected large bone defect and massive soft-tissue loss of leg—is free flap reconstruction inevitable?. International Orthopaedics (SICOT) 45, 3033–3043 (2021). https://doi.org/10.1007/s00264-021-05154-7

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  • DOI: https://doi.org/10.1007/s00264-021-05154-7

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