Valencia, Spain From Reconstructive Surgery, Clínica Cavadas, and Fundación Pedro Cavadas.
Plast Reconstr Surg. 2010 Jan;125(1):215-223. doi: 10.1097/PRS.0b013e3181c495b3.
Segmental bone defects of the tibia after high-energy trauma are limb-threatening conditions. Multiple treatment options have been proposed, including nonvascularized bone grafts, vascularized bone transfers, and callus distraction. A series of 41 patients with major segmental defects of the tibia treated with vascularized bone reconstruction is presented.
Forty-one acute or nonacute segmental bone defects of the tibia, 4 cm or more in length, were included in the series. In acute defects (nine cases), a single-stage or two-stage reconstruction with vascularized bone transfer was performed. In nonacute segmental infected bone defects (32 cases), single-stage reconstruction with vascularized bone transfer (seven cases) or two-stage reconstruction with vascularized bone transfer (25 cases) was performed. Reconstruction was performed with fibular flaps in 38 cases (36 contralateral free and two ipsilateral pedicled flaps) and iliac flaps in three cases. Bone fixation was performed with screws and external fixation, with early conversion to locking plate internal fixation.
Two fibular flaps needed urgent revision for venous congestion. One fibular flap was lost. Infection after vascularized bone transfer occurred in two delayed reconstructions. Bone healing occurred in all cases. Stress fractures occurred in three fibular flaps. Time to bone union was 5 to 9 months, and time to full weight bearing was 9 to 14 months.
The use of vascularized bone transfer in the treatment of major segmental tibial defects was successful in the present series. The management of bone fixation and infection in these cases is discussed.
高能创伤后胫骨节段性骨缺损是危及肢体的病症。已经提出了多种治疗选择，包括非血管化骨移植物、血管化骨转移和骨痂牵张。本文介绍了采用血管化骨重建治疗 41 例胫骨大节段缺损的患者。
本系列纳入了 41 例胫骨急性或非急性节段性骨缺损患者，缺损长度为 4 厘米或以上。在急性缺损（9 例）中，采用血管化骨转移的一期或二期重建。在非急性节段性感染性骨缺损（32 例）中，采用血管化骨转移的一期重建（7 例）或二期重建（25 例）。重建采用腓骨瓣 38 例（对侧游离腓骨瓣 36 例，同侧带蒂腓骨瓣 2 例），髂骨瓣 3 例。骨固定采用螺钉和外固定，早期转换为锁定钢板内固定。
2 例腓骨瓣因静脉淤血需要紧急修改，1 例腓骨瓣丢失。2 例延迟重建后发生血管化骨转移感染。所有病例均发生骨愈合。3 例腓骨瓣发生应力性骨折。骨愈合时间为 5 至 9 个月，完全负重时间为 9 至 14 个月。
在本系列中，采用血管化骨转移治疗胫骨大节段缺损是成功的。讨论了这些病例中骨固定和感染的处理。
