TIBIAL PERIOSTEAL FLAP PEDICLED WITH INTERMUSCULAR BRANCH OF POSTERIOR TIBIAL VESSELS COMBINED WITH AUTOLOGOUS BONE GRAFT FOR TIBIAL BONE DEFECT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

NIYulong ,  GAOShunhong , ZHANGJingyu , DONGHuishuang , ZHANGYunpeng , FUJiansong

No. 2 Department of Hand Surgery, the Second Hospital of Tangshan(North China University of Science and Technology Affilated Orthopedic Hospital), Tangshan Hebei, 063000, P. R. China;

Corresponding author：

GAOShunhong, Email: gshdj@126.com

Keywords：

Posterior tibial vessel; Periosteal flap; Tibial bone defect; Soft tissue defect; Bone transplantation; Repair

DOI：

10.7507/1002-1892.20150265

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Objective To investigate the effectiveness of tibial periosteal flap pedicled with intermuscular branch of posterior tibial vessels combined with autologous bone graft in the treatment of tibial bone defects. Methods Between January 2007 and December 2013, 19 cases of traumatic tibia bone and soft tissue defects were treated. There were 14 males and 5 females, aged from 18 to 49 years (mean, 28 years). The tibial fracture site located at the middle tibia in 6 cases and at the distal tibia in 13 cases. According to Gustilo type, 4 cases were rated as type Ⅲ A, 14 cases as type Ⅲ B, and 1 case as type Ⅲ C (injury of anterior tibial artery). The length of bone defect ranged from 4.3 to 8.5 cm (mean, 6.3 cm). The soft tissue defects ranged from 8 cm×5 cm to 17 cm×9 cm. The time from injury to operation was 3 to 8 hours (mean, 4 hours). One-stage operation included debridement, external fixation, and vacuum sealing drainage. After formation of granulation tissue, the fresh wound was repaired with sural neurovascular flap or posterior tibial artery perforator flap. The flap size ranged from 10 cm×6 cm to 19 cm×11 cm. In two-stage operation, tibial periosteal flap pedicled with intermuscular branch of posterior tibial vessels combined with autologous bone graft was used to repair tibial defect. The periosteal flap ranged from 6.5 cm×4.0 cm to 9.0 cm×5.0 cm; bone graft ranged from 4.5 to 9.0 cm in length. External fixation was changed to internal fixation. Results All flaps survived with soft texture, and no ulcer and infection occurred. All incisions healed by the first intention. All patients were followed up 18-40 months (mean, 22.5 months). All graft bone healed, with the healing time from 3 to 9 months (mean, 6.5 months). No complication of implant loosening or fracture was observed. No pain and abnormal activity in the affected leg occurred. All patients resumed weight-bearing and walking function. The length of the limb was recovered and difference value was 0.5-1.5 cm between normal and affected sides. The function of the knee and ankle joint was good without infection, malunion, and equinus. According to the Johner standard at last follow-up, the results were excellent in 15 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate of 94.7%. Conclusion Tibial periosteal flap pedicled with intermuscular branch of posterior tibial vessels combined with autologous bone graft is an effective method to treat bone defect of the tibia.

Citation： NIYulong, GAOShunhong, ZHANGJingyu, DONGHuishuang, ZHANGYunpeng, FUJiansong. TIBIAL PERIOSTEAL FLAP PEDICLED WITH INTERMUSCULAR BRANCH OF POSTERIOR TIBIAL VESSELS COMBINED WITH AUTOLOGOUS BONE GRAFT FOR TIBIAL BONE DEFECT. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(10): 1221-1225. doi: 10.7507/1002-1892.20150265 Copy

1.	陈振光. 带血供胫骨骨膜瓣移位术的解剖与临床应用. 中华显微外科杂志, 2000, 23(2):157-159.
2.	侯春林. 自体组织移植进展. 中国修复重建外科杂志, 2006, 20(4): 309-312.
3.	Cavadas PC, Landín L, Ibáñez J, et al. Reconstruction of major traumatic segmental bone defects of the tibia with vascularized bone transfers. Plast Reconstr Surg, 2010, 125(1):215-223.
4.	王华, 孟琳, 马华, 等. 腓浅血管筋膜蒂胫腓骨膜瓣治疗胫骨骨不连. 中国修复重建外科杂志, 2009, 23(11):1326-1328.
5.	Johner R, Wrueh O. Classification of tibial shaft fractures and correlation with results after rigid fixation. Clin Orthop Relat Res, 1983, (178):7-25.
6.	陈振光, 张发惠, 余国荣, 等. 带血供胫骨内侧面骨膜瓣移位术. 中华实验外科杂志, 1997, 14(6):349-350.
7.	Masquelet AC, Roman MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves anatomic study and clinical experience in the leg. Plast Reconstr Surg, 1992, 89(6): 1115-1121.
8.	徐永清, 朱跃良, 范新宇, 等. 二处截骨骨搬移治疗胫骨大段骨缺损合并软组织缺损. 中华创伤骨科杂志, 2012, 14(10):831-834.
9.	Robert Rozbruch S, Weitzman AM, Tracey Watson J, et al. Simultaneous treatment of tibial bone and soft-tissue defects with the ilizarov method. J Orthop Trauma, 2006, 20(3):197-205.
10.	刘会仁, 王立新, 张艳茂, 等. 组织移植结合骨滑移治疗小腿皮肤软组织伴大段胫骨缺损. 中国修复重建外科杂志, 2013, 27(3): 295-298.
11.	Sala F, Thabet AM, Castelli F, et al. Bone transport for postinfectious segmental tibial bone defects with a combined ilizarov/taylor spatial frametechnique. J Orthop Trauma, 2011, 25(3):162-168.
12.	殷渠东, 孙振中, 顾三军, 等. 骨搬运与骨短缩-延长治疗胫骨骨缺损合并软组织缺损的疗效比较. 中国修复重建外科杂志, 2014, 28(7):818-822.
13.	谢武昆, 杨徘, 崔杰, 等. 锁定接骨板自体髂骨移植治疗老年胫腓骨中下段粉碎性骨折. 临床骨科杂志, 2012, 15(6):661-662.
14.	胥少汀, 葛宝丰, 徐印坎. 实用骨科学. 4版. 北京:人民军医出版社, 2012:1167-1168.
15.	Soldado F, Knorr J, Haddad S, et al. Vascularized tibial periosteal graft in complex cases of bone nonunion in children. J Microsurgery, 2015, 35(3):239-243.
16.	Choudry UH, Bakri K, Moran SL, et al. The vascularized medial femoral condyle periosteal bone flap for the treatment of recalcitrant bony nonunions. J Ann Plast Surg, 2008, 60(2):174-180.
17.	毛莉颖, 黄东, 吴伟炽, 等. 带监测皮岛的胫前动脉穿支骨膜瓣在骨不连治疗中的应用. 中华显微外科杂志, 2013, 36(2):194-195.
18.	Vögelin E, Jones NF, Huang JI, et al. Healing of a critical-sized defect in the rat femur with use of a vascularized periosteal flap, a biodegradable matrix, and bone morphogenetic protein. J Bone Joint Surg (Am), 2005, 87(6):1323-1331.

1. 陈振光. 带血供胫骨骨膜瓣移位术的解剖与临床应用. 中华显微外科杂志, 2000, 23(2):157-159.
2. 侯春林. 自体组织移植进展. 中国修复重建外科杂志, 2006, 20(4): 309-312.
3. Cavadas PC, Landín L, Ibáñez J, et al. Reconstruction of major traumatic segmental bone defects of the tibia with vascularized bone transfers. Plast Reconstr Surg, 2010, 125(1):215-223.
4. 王华, 孟琳, 马华, 等. 腓浅血管筋膜蒂胫腓骨膜瓣治疗胫骨骨不连. 中国修复重建外科杂志, 2009, 23(11):1326-1328.
5. Johner R, Wrueh O. Classification of tibial shaft fractures and correlation with results after rigid fixation. Clin Orthop Relat Res, 1983, (178):7-25.
6. 陈振光, 张发惠, 余国荣, 等. 带血供胫骨内侧面骨膜瓣移位术. 中华实验外科杂志, 1997, 14(6):349-350.
7. Masquelet AC, Roman MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves anatomic study and clinical experience in the leg. Plast Reconstr Surg, 1992, 89(6): 1115-1121.
8. 徐永清, 朱跃良, 范新宇, 等. 二处截骨骨搬移治疗胫骨大段骨缺损合并软组织缺损. 中华创伤骨科杂志, 2012, 14(10):831-834.
9. Robert Rozbruch S, Weitzman AM, Tracey Watson J, et al. Simultaneous treatment of tibial bone and soft-tissue defects with the ilizarov method. J Orthop Trauma, 2006, 20(3):197-205.
10. 刘会仁, 王立新, 张艳茂, 等. 组织移植结合骨滑移治疗小腿皮肤软组织伴大段胫骨缺损. 中国修复重建外科杂志, 2013, 27(3): 295-298.
11. Sala F, Thabet AM, Castelli F, et al. Bone transport for postinfectious segmental tibial bone defects with a combined ilizarov/taylor spatial frametechnique. J Orthop Trauma, 2011, 25(3):162-168.
12. 殷渠东, 孙振中, 顾三军, 等. 骨搬运与骨短缩-延长治疗胫骨骨缺损合并软组织缺损的疗效比较. 中国修复重建外科杂志, 2014, 28(7):818-822.
13. 谢武昆, 杨徘, 崔杰, 等. 锁定接骨板自体髂骨移植治疗老年胫腓骨中下段粉碎性骨折. 临床骨科杂志, 2012, 15(6):661-662.
14. 胥少汀, 葛宝丰, 徐印坎. 实用骨科学. 4版. 北京:人民军医出版社, 2012:1167-1168.
15. Soldado F, Knorr J, Haddad S, et al. Vascularized tibial periosteal graft in complex cases of bone nonunion in children. J Microsurgery, 2015, 35(3):239-243.
16. Choudry UH, Bakri K, Moran SL, et al. The vascularized medial femoral condyle periosteal bone flap for the treatment of recalcitrant bony nonunions. J Ann Plast Surg, 2008, 60(2):174-180.
17. 毛莉颖, 黄东, 吴伟炽, 等. 带监测皮岛的胫前动脉穿支骨膜瓣在骨不连治疗中的应用. 中华显微外科杂志, 2013, 36(2):194-195.
18. Vögelin E, Jones NF, Huang JI, et al. Healing of a critical-sized defect in the rat femur with use of a vascularized periosteal flap, a biodegradable matrix, and bone morphogenetic protein. J Bone Joint Surg (Am), 2005, 87(6):1323-1331.

Chinese Journal of Reparative and Reconstructive Surgery

TIBIAL PERIOSTEAL FLAP PEDICLED WITH INTERMUSCULAR BRANCH OF POSTERIOR TIBIAL VESSELS COMBINED WITH AUTOLOGOUS BONE GRAFT FOR TIBIAL BONE DEFECT

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