APPLICATION OF ONE STAGE VACUUM SEALING DRAINAGE COMBINED WITH BI-PEDICLE SLIDING FLAP TRANSPLANTATION FOR OPEN TIBIOFIBULAR FRACTURE AND SOFT TISSUE DEFECTS OF THE LOWER LEG_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YEGuoqiang ¹ , FUGuo ² ,  QIJian ²

1. Department of Orthopedic Trauma and Microsurgery, the Orthopedic Hospital Affiliated to Guangdong University of Traditional Chinese Medicine, Guangzhou Guangdong, 510240, P. R. China;
2. Department of Hand Surgery, Orthopedic Trauma and Microsurgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou Guangdong, 510240, P. R. China;

Corresponding author：

QIJian, Email: speedsnow@126.com

Keywords：

acuum sealing drainage; Bi-pedicle sliding flap; Open fracture; Tibiofibular fracture; Soft tissue defect

DOI：

10.7507/1002-1892.20150206

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Objective To evaluate the effectiveness of one stage vacuum sealing drainage (VSD) combined with bi-pedicle sliding flap transplantation in repairing open tibiofibular fracture and soft tissue defects of the lower leg. Methods Twenty-five patients with open tibiofibular fracture and soft tissue defects of the lower leg were treated by VSD combined with bi-pedicle sliding flap transplantation between January 2012 and July 2014. There were 18 males and 7 females, aged 12-65 years (mean, 35.2 years). The injury causes included traffic accident injury (20 cases), falling injury from height (3 cases), and heavy pound injury (2 cases). The left side was involved in 14 cases, the right side in 8 cases, and both sides in 3 cases. According to Gustilo classification, injury was rated as type II (6 lower extremities), type III a (19 lower extremities), and type III b (3 lower extremities). The anterior tibial defect area after debridement ranged from 6 cm×3 cm to 12 cm×5 cm. The course of injury and admission was 1-18 hours (mean, 4.5 hours). An anterior tibial bi-pedicle sliding flap of 24 cm×6 cm to 48 cm×8 cm was designed to cover the wound and tibia fracture was fixed with minimally invasive internal fixation. After suturing the anterior tibial wound without tension, the flap was transferred forward. The exposed fibula was fixed with reconstruction plate. The remained wound was covered by VSD. Continuously antibiotic saline irrigation was applied postoperatively. After 15 days, the VSD dressing was removed and free skin graft was used to cover the remained wound. Results After the VSD dressing was removed, the wounds and tension-reduced wound of 18 lower extremities completely healed. Unhealing wounds were covered by skin graft in 9 lower extremities. Infection occurred in 1 lower extremity and was cured after treated with antibiotics. All the wounds healed and flaps survived. The patients were followed up 6-24 months (mean, 18 months). The fractures union was confirmed by X-ray and the average union time was 3.2 months (range, 2.5-5 months). Conclusion The application of one stage VSD combined with bi-pedicle sliding flap transposition is a simple and safe treatment regimen for Gustilo type II-IIIa open tibiofibular fracture and soft tissue defects of the lower leg. It has the advantages of few complications and low costs, short hospitalization, and good effectiveness.

Citation： YEGuoqiang, FUGuo, QIJian. APPLICATION OF ONE STAGE VACUUM SEALING DRAINAGE COMBINED WITH BI-PEDICLE SLIDING FLAP TRANSPLANTATION FOR OPEN TIBIOFIBULAR FRACTURE AND SOFT TISSUE DEFECTS OF THE LOWER LEG. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(8): 955-958. doi: 10.7507/1002-1892.20150206 Copy

1.	Ashraf MO,Jones HM,Kanvinde R.Acute traumatic fracture dislocation of proximal tibiofibular joint:Case report and literature review.Injury,2015,46(7):1400-1402.
2.	Zhang Y,Zhuang Y,Wang B,et al.Single-incision approach improves wound healing and bone union for treating mid-to-lower segment of tibiofibular fracture.Int J Clin Exp Med,2015,8(3):4269-4274.
3.	Wang D,Xiang JP,Chen XH,et al.A meta-analysis for postoperative complications in tibial plafond fracture:open reduction and internal fixation versus limited internal fixation combined with external fixator.J Foot Ankle Surg,2015,54(4):646-651.
4.	Rodrigues FL,de Abreu LC,Valenti VE,et al.Bone tissue repair in patients with open diaphyseal tibial fracture treated with biplanar external fixation or reamed locked intramedullary nailing.Injury,2014,45 Suppl 5:S32-S35.
5.	Penn-Barwell JG,Myatt RW,Bennett PM,et al.Medium-term outcomes following limb salvage for severe open tibia fracture are similar to trans-tibial amputation.Injury,2015,46(2):288-291.
6.	Nemoto M,Ishikawa S,Kounoike N,et al.Free flap transfer to preserve main arterial flow in early reconstruction of open fracture in the lower extremity.Plast Surg Int,2015,2015:213892.
7.	Sood A,Khamsi B,Datiashvili R,et al.Use of cross-leg flap for wound complications resulting from open pilon fracture.Am J Orthop (Belle Mead NJ),2015,44(3):131-134.
8.	Pérez-Rivera OM,Palanco-Domínguez LE,Ortiz-Rivera T,et al.Internal and external fixation for open tibial fracture.Case presentation.Acta Ortop Mex,2013,27(4):256-259.
9.	Wei SJ,Cai XH,Wang HS,et al.A comparison of primary and delayed wound closure in severe open tibial fractures initially treated with internal fixation and vacuum-assisted wound coverage:a case-controlled study.Int J Surg,2014,12(7):688-694.
10.	van Dreumel RL,van Wunnik BP,Janssen L,et al.Mid-to long-term functional outcome after open reduction and internal fixation of tibial plateau fractures.Injury,2015.[Epub ahead of print].
11.	Katsumura T,Hirase Y,Fukumoto K,et al.Use of free ipsilateral gastrocnemius flap for coverage of distal third tibial defect after Gustilo type Ⅲ open fracture.J Reconstr Microsurg,2013,29(2):113-116.
12.	Cheng HT,Hsu YC,Wu CI.Risk of infection with delayed wound coverage by using negative-pressure wound therapy in Gustilo Grade ⅢB/ⅢC open tibial fracture:an evidence-based review.J Plast Reconstr Aesthet Surg,2013,66(6):876-878.
13.	韩立仁,赵北,穆卫东,等.外固定架加钢板治疗伴有胫骨骨缺损的开放性胫腓骨骨折.中华创伤杂志,2013,29(3):258-261.
14.	陆男吉,钟永翔,文根,等.远端蒂隐神经营养血管皮瓣联合封闭负压吸引技术在胫骨远端钢板外露中的临床应用.中华显微外科杂志,2012,35(6):457-459.
15.	杨钦泰,李晓文,欧春培,等.骨筋膜室综合征的早期诊断与治疗.中华创伤骨科杂志,2009,11(7):691-692.
16.	刘桂花,陈坤峰,赵志坚,等.负压封闭引流配合腓肠肌皮瓣移植治疗胫骨外露创面.中华显微外科杂志,2011,34(4):326-327.
17.	杜全红,丛海波,史永安,等.封闭式负压引流技术联合开放植骨治疗胫骨创伤性骨髓炎.中国修复重建外科杂志,2014,28(5):562-565.
18.	杨佐明,刘晓明,戴士峰,等.胫腓骨骨折术后感染的治疗分析.中国修复重建外科杂志,2011,25(9):1151-1152.

1. Ashraf MO,Jones HM,Kanvinde R.Acute traumatic fracture dislocation of proximal tibiofibular joint:Case report and literature review.Injury,2015,46(7):1400-1402.
2. Zhang Y,Zhuang Y,Wang B,et al.Single-incision approach improves wound healing and bone union for treating mid-to-lower segment of tibiofibular fracture.Int J Clin Exp Med,2015,8(3):4269-4274.
3. Wang D,Xiang JP,Chen XH,et al.A meta-analysis for postoperative complications in tibial plafond fracture:open reduction and internal fixation versus limited internal fixation combined with external fixator.J Foot Ankle Surg,2015,54(4):646-651.
4. Rodrigues FL,de Abreu LC,Valenti VE,et al.Bone tissue repair in patients with open diaphyseal tibial fracture treated with biplanar external fixation or reamed locked intramedullary nailing.Injury,2014,45 Suppl 5:S32-S35.
5. Penn-Barwell JG,Myatt RW,Bennett PM,et al.Medium-term outcomes following limb salvage for severe open tibia fracture are similar to trans-tibial amputation.Injury,2015,46(2):288-291.
6. Nemoto M,Ishikawa S,Kounoike N,et al.Free flap transfer to preserve main arterial flow in early reconstruction of open fracture in the lower extremity.Plast Surg Int,2015,2015:213892.
7. Sood A,Khamsi B,Datiashvili R,et al.Use of cross-leg flap for wound complications resulting from open pilon fracture.Am J Orthop (Belle Mead NJ),2015,44(3):131-134.
8. Pérez-Rivera OM,Palanco-Domínguez LE,Ortiz-Rivera T,et al.Internal and external fixation for open tibial fracture.Case presentation.Acta Ortop Mex,2013,27(4):256-259.
9. Wei SJ,Cai XH,Wang HS,et al.A comparison of primary and delayed wound closure in severe open tibial fractures initially treated with internal fixation and vacuum-assisted wound coverage:a case-controlled study.Int J Surg,2014,12(7):688-694.
10. van Dreumel RL,van Wunnik BP,Janssen L,et al.Mid-to long-term functional outcome after open reduction and internal fixation of tibial plateau fractures.Injury,2015.[Epub ahead of print].
11. Katsumura T,Hirase Y,Fukumoto K,et al.Use of free ipsilateral gastrocnemius flap for coverage of distal third tibial defect after Gustilo type Ⅲ open fracture.J Reconstr Microsurg,2013,29(2):113-116.
12. Cheng HT,Hsu YC,Wu CI.Risk of infection with delayed wound coverage by using negative-pressure wound therapy in Gustilo Grade ⅢB/ⅢC open tibial fracture:an evidence-based review.J Plast Reconstr Aesthet Surg,2013,66(6):876-878.
13. 韩立仁,赵北,穆卫东,等.外固定架加钢板治疗伴有胫骨骨缺损的开放性胫腓骨骨折.中华创伤杂志,2013,29(3):258-261.
14. 陆男吉,钟永翔,文根,等.远端蒂隐神经营养血管皮瓣联合封闭负压吸引技术在胫骨远端钢板外露中的临床应用.中华显微外科杂志,2012,35(6):457-459.
15. 杨钦泰,李晓文,欧春培,等.骨筋膜室综合征的早期诊断与治疗.中华创伤骨科杂志,2009,11(7):691-692.
16. 刘桂花,陈坤峰,赵志坚,等.负压封闭引流配合腓肠肌皮瓣移植治疗胫骨外露创面.中华显微外科杂志,2011,34(4):326-327.
17. 杜全红,丛海波,史永安,等.封闭式负压引流技术联合开放植骨治疗胫骨创伤性骨髓炎.中国修复重建外科杂志,2014,28(5):562-565.
18. 杨佐明,刘晓明,戴士峰,等.胫腓骨骨折术后感染的治疗分析.中国修复重建外科杂志,2011,25(9):1151-1152.

Chinese Journal of Reparative and Reconstructive Surgery

APPLICATION OF ONE STAGE VACUUM SEALING DRAINAGE COMBINED WITH BI-PEDICLE SLIDING FLAP TRANSPLANTATION FOR OPEN TIBIOFIBULAR FRACTURE AND SOFT TISSUE DEFECTS OF THE LOWER LEG

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