Three-stage limb salvage in tibial fracture related infection with composite bone and soft-tissue defect
Corona Pérez-Cardona, Pablo S (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Carbonell-Rosell, Carla (Hospital Universitari Vall d'Hebron)
Vicente, Matías (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Serracanta, Jordi (Hospital Universitari Vall d'Hebron)
Tetsworth, Kevin (Orthopaedic Research Centre of Australia)
Glatt, Vaida (Department of Orthopaedic Surgery. University of Texas Health Science Center San Antonio)
Universitat Autònoma de Barcelona. Departament de Cirurgia

Date:	2021
Abstract:	Introduction: Managing critical-sized tibial defects is one of the most complex challenges orthopedic surgeons face. This is even more problematic in the presence of infection and soft-tissue loss. The purpose of this study is to describe a comprehensive three-stage surgical protocol for the reconstruction of infected tibial injuries with combined bone defects and soft-tissue loss, and report the clinical outcomes. Materials and methods: A retrospective study at a specialized limb reconstruction center identified all patients with infected tibial injuries with bone and soft-tissue loss from 2010 through 2018. Thirty-one patients were included. All cases were treated using a three-stage protocol: (1) infected limb damage control; (2) soft-tissue coverage with a vascularized or local flap; (3) definitive bone reconstruction using distraction osteogenesis principles with external fixation. Primary outcomes: limb salvage rate and infection eradication. Secondary outcomes: patient functional outcomes and satisfaction. Results: Patients in this series of chronically infected tibias had been operated upon 3. 4 times on average before starting our limb salvage protocol. The mean soft-tissue and bone defect sizes were 124 cm (6-600) and 5. 4 cm (1-23), respectively. A free flap was performed in 67. 7% (21/31) of the cases; bone transport was the selected bone-reconstructive option in 51. 7% (15/31). Local flap failure rate was 30% (3/10), with 9. 5% for free flaps (2/21). Limb salvage rate was 93. 5% (29/31), with infection eradicated in all salvaged limbs. ASAMI bone score: 100% good/excellent. Mean VAS score was 1. 0, and ASAMI functional score was good/excellent in 86% of cases. Return-to-work rate was 83%; 86% were "very satisfied" with the treatment outcome. Conclusion: A three-stage surgical approach to treat chronically infected tibial injuries with combined bone and soft-tissue defects yields high rates of infection eradication and successful limb salvage, with favorable functional outcomes and patient satisfaction.
Note:	Altres ajuts: acords transformatius de la UAB
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Bone transport ; Infected tibial injury ; Limb salvage ; Limb-threatening injuries ; Distraction osteogenesis ; Fasciocutaneous free fap
Published in:	Archives of Orthopaedic and Trauma Surgery, 2021 , ISSN 1434-3916

DOI: 10.1007/s00402-021-04299-9
PMID: 34936017

11 p, 1.2 MB

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