Bibbo Christopher, Bauder Andrew R, Nelson Jonas, Ahn Jaimo, Levin L Scott, Mehra Samir, Kovach Stephen J
From the Rubin Institute for Advanced Orthopedics/International Center for Limb Lengthening, Sinai Hospital of Baltimore, Baltimore, MD.
Division of Plastic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
Ann Plast Surg. 2020 Nov;85(5):516-521. doi: 10.1097/SAP.0000000000002240.
Traumatic intercalary defects of the tibia may be effectively managed with the free fibula flap. However, any alteration of limb alignment with residual bony angular deformity of the tibia must be also addressed. We describe the use of the free fibula flap in conjunction with external fixation to allow residual deformity correction and patient mobilization ambulation during healing of the free flap.
Retrospective medical record review was conducted of patients with segmental tibial defects greater than 7 cm who underwent reconstruction with fibula free flap and simple pin-bar external fixation, followed by conversion to 6-axis computer-assisted multiplanar circular ring external fixation to correct residual bony deformity. Outcomes analyses included free flap complications, return to the operating room, complications associated with the external fixation, bony union, correction of residual deformity, amputation rate, visual analog pain scales, and patient satisfaction.
Eight patients (8 tibiae) underwent reconstruction. Mean tibial bone defect was 10.2 cm; all limbs had soft-tissue defects (mean size, 138 cm). Free fibula grafts were harvested as osteocutaneous or osteomyocutaneous flaps (average length, 12 cm). Complications included 1 delayed union and 3 (37.5%) patients readmitted for graft fracture. Ultimately, 100% of patients achieved graft union with satisfactory correction of residual limb deformity. Limb salvage rate was 100%.
Management of segmental tibial bone loss utilizing initial simple external fixation and microsurgical reconstruction followed by application of computer-assisted circular external fixator may provide a reliable reconstructive protocol for posttraumatic tibial defects with residual bone malalignment.
游离腓骨瓣可有效治疗胫骨创伤性节段性缺损。然而，胫骨残留骨角畸形导致的肢体对线改变也必须得到解决。我们描述了游离腓骨瓣结合外固定的应用，以在游离瓣愈合期间矫正残留畸形并使患者能够活动行走。
对接受游离腓骨瓣重建和简单针杆外固定，随后转换为六轴计算机辅助多平面环形外固定以矫正残留骨畸形的胫骨节段性缺损大于7 cm的患者进行回顾性病历审查。结果分析包括游离瓣并发症、重返手术室情况、与外固定相关的并发症、骨愈合、残留畸形矫正、截肢率、视觉模拟疼痛量表以及患者满意度。
8例患者（8条胫骨）接受了重建。胫骨平均骨缺损为10.2 cm；所有肢体均有软组织缺损（平均大小为138 cm）。游离腓骨移植采用骨皮瓣或骨肌皮瓣（平均长度为12 cm）。并发症包括1例延迟愈合和3例（37.5%）因移植骨骨折再次入院。最终，100%的患者实现了移植骨愈合，残留肢体畸形得到满意矫正。肢体挽救率为100%。
利用初始简单外固定和显微外科重建，随后应用计算机辅助环形外固定器治疗胫骨节段性骨缺损，可为伴有残留骨排列不齐的创伤后胫骨缺损提供可靠的重建方案。
