Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain.
Arch Orthop Trauma Surg. 2022 Dec;142(12):3877-3887. doi: 10.1007/s00402-021-04299-9. Epub 2021 Dec 22.
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.
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.
limb salvage rate and infection eradication.
patient functional outcomes and satisfaction.
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.
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.
处理临界尺寸的胫骨缺损是骨科医生面临的最复杂挑战之一。在存在感染和软组织损失的情况下，问题更加严重。本研究的目的是描述一种综合的三阶段手术方案，用于重建感染性胫骨损伤伴骨缺损和软组织损失，并报告临床结果。
在专门的肢体重建中心进行回顾性研究，确定了 2010 年至 2018 年期间患有感染性胫骨损伤伴骨和软组织损失的所有患者。共纳入 31 例患者。所有病例均采用三阶段方案治疗：（1）感染肢体损伤控制；（2）采用血管化或局部皮瓣进行软组织覆盖；（3）使用外固定器进行牵张成骨原则的确定性骨重建。
保肢率和感染清除率。
患者的功能结果和满意度。
在开始我们的保肢方案之前，该系列慢性感染胫骨患者平均已接受了 3.4 次手术。平均软组织和骨缺损大小分别为 124cm（6-600）和 5.4cm（1-23）。67.7%（21/31）的病例采用游离皮瓣；51.7%（15/31）的病例选择骨重建为骨搬运。局部皮瓣失败率为 30%（3/10），游离皮瓣为 9.5%（2/21）。保肢率为 93.5%（29/31），所有保肢均消除了感染。ASAMI 骨评分：100%为优/良。平均 VAS 评分为 1.0，86%的病例 ASAMI 功能评分为优/良。重返工作率为 83%；86%的患者对治疗结果“非常满意”。
采用三阶段手术方法治疗感染性胫骨损伤伴骨和软组织缺损，可获得高感染清除率和成功保肢率，功能结果和患者满意度良好。
