Posttraumatic Bone Infections
Semi-open cancellous bone grafting for infected bone defect combined with soft tissue defect of lower limb
Tianhao Wu, Yanlong Zhang, Yong Wang, Xiao Zhang, Shuwei Tian, Xirui Wu, Aqin Peng
Published 2019-02-15
Cite as Chin J Trauma, 2019, 35(2): 101-108. DOI: 10.3760/cma.j.issn.1001-8050.2019.02.002
Abstract
ObjectiveTo investigate the clinical efficacy of semi-open cancellous bone grafting for infected bone defect combined with soft tissue defect of lower limb.
MethodsA retrospective case control study was conducted to analyze the clinical data of 26 patients with infected bone defect combined with soft tissue defect of lower limb admitted to the Third Hospital of Hebei Medical University from March 2010 to August 2017. There were 16 males and 10 females, aged 16-65 years [(39.6±12.8)years]. The bone defect area before bone grafting was 1.4-6.0 cm [(3.3±1.2)cm]. The surface soft tissue defect of bone graft granules was 2.3 cm×1.1 cm-8.5 cm×5.0 cm after bone grafting. If the defect was segmental defect of more than 6 cm, the defect was firstly reduced by bone transport. When the defect was near the docking point, the bone defect was repaired by open bone grafting. If the defect was located at the metaphyseal end of the calcaneus or tibia, stage I or stage II open bone grafting was performed after debridement. After bone grafting, antibiotic-containing cement sheets were used to cover the wound in 14 patients (semi-open group), and vacuum sealing drainage (VSD) devices were used to cover the wound in 12 patients (VSD group). The time of granulation tissue covering bone graft granules, wound healing time, bone defect healing time, material cost and complications (wound infection and necrosis of bone graft granules) were compared between the two groups. The limb function was evaluated according to Paley score.
ResultsAll patients were followed up for 12-40 months [(19.3±7.2)months]. In the semi-open group and VSD group, the time of granulation tissue coverage was 22.2 days (15.0-44.0)days and 20.2 days (15.0-44.0)days (P>0.05); wound healing time was 3.1 months (1.5-5.5)months and 3.1 months (1.5-6.5)months (P>0.05); bone defect healing time was (5.5±2.2)months and (5.9±2.4)months (P>0.05); the cost of covering wound materials was (2 056.1±23.4)yuan and (5 555.3±1 105.5)yuan respectively (P<0.05). No wound infection occurred in either group. Two patients in the semi-open group and one patient in the VSD group had bone graft granules surface necrosis (P>0.05). According to Paley's functional score, the results were excellent in 12 patients and good in two in the semiopen group, compared with excellent in 11 and good in one in the VSD group (P>0.05).
ConclusionFor infected bone defect combined with soft tissue defect of lower limb, semi-open bone grafting can simplify the nursing of wound, prevent wound infection, promote wound healing and fracture healing. It has similar therapeutic effect with VSD, but its treatment cost is significantly reduced.
Key words:
Lower extremity; Osteomyelitis; Fractures, ununited; Bone transplantation; Soft tissue injuries
Contributor Information
Tianhao Wu
Key Laboratory of Orthopedical Biomechanics of Hebei Province, Orthopedic Institute of Hebei Province, Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
Yanlong Zhang
Key Laboratory of Orthopedical Biomechanics of Hebei Province, Orthopedic Institute of Hebei Province, Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
Yong Wang
Key Laboratory of Orthopedical Biomechanics of Hebei Province, Orthopedic Institute of Hebei Province, Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
Xiao Zhang
Key Laboratory of Orthopedical Biomechanics of Hebei Province, Orthopedic Institute of Hebei Province, Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
Shuwei Tian
Key Laboratory of Orthopedical Biomechanics of Hebei Province, Orthopedic Institute of Hebei Province, Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
Xirui Wu
Key Laboratory of Orthopedical Biomechanics of Hebei Province, Orthopedic Institute of Hebei Province, Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
Aqin Peng
Key Laboratory of Orthopedical Biomechanics of Hebei Province, Orthopedic Institute of Hebei Province, Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
