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Distraction osteogenesis with free tissue transfer allows salvage of the infected, traumatised lower extremity
Harvey Chim, John K Sontich, Bram R Kaufman
Case Western Reserve University
2010-03-26
Presenter: Harvey Chim
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Salvage of large acute and chronic tibial bone defects in the lower extremity poses a formidable problem. Here we describe our experience using free tissue transfer with distraction osteogenesis for treatment of composite osteocutaneous defects due to infected nonunion, trauma and soft tissue loss.
Methods: We reviewed a consecutive series of 28 patients who underwent treatment over an 8-year period, with follow-up ranging from 1 to 8.5 years. Mean time to flap post injury was 1082 days (range 6 days to 30 years). Indications for treatment included infected nonunion of the tibia (n=18), acute traumatic bone loss (n=5), skin and soft tissue breakdown resulting from distraction osteogenesis (n=4) and exposed bone following previous failed free flap (n=1).
Results: Free flaps used included the following: rectus abdominis (n=17), latissimus dorsi (n=5), gracilis (n=5) and radial forearm (n=1). Mean length of bone gap was 63mm (range 30 to 140) and mean area of wound requiring flap coverage was 219 cm2 (range 35 to 400). Twenty-five patients (89.3%) had successful flap coverage, and went on to ambulate independently and return to work. Minor complication rate was 42.9%.
Conclusion: Distraction osteogenesis in combination with free tissue transfer, is a powerful technique that allows limb salvage in the lower extremity. For infected nonunion of the tibia, it should be considered as the first choice of treatment due to: 1) staged approach to allow underlying osteomyelitis to declare itself; 2) ability to use a smaller free flap due to stretching of soft tissues from distraction.
