ObjectiveTo investigate the effectiveness of flap combined with induced membrane technique in treatment of post-traumatic tibial osteomyelitis with soft tissue defect. Methods A clinical data of 33 patients with post-traumatic tibial osteomyelitis with soft tissue defect who met the selection criteria between August 2015 and October 2018 was retrospectively analyzed. There were 21 males and 12 females. The age ranged from 19 to 70 years, with an average of 39 years. The osteomyelitis located in the upper 1/3 of tibia in 8 cases, in the middle 1/3 of tibia in 14 cases, and in the lower 1/3 of tibia in 11 cases. According to Cierny-Mader classification standard, 19 cases of osteomyelitis were type Ⅲ and 14 cases were type Ⅳ. The duration of osteomyelitis ranged from 2 months to 20 years (median, 3 months). In the first-stage operation, after radical debridement, the length of bone defect was 1.5-12.5 cm (mean, 5.0 cm) and the size of soft tissue defects ranged from 5 cm×4 cm to 15 cm×12 cm. Bone cement containing antibiotics was implanted into the bone defect and the personalized flap was used to repair the wound. After the wound healed at 6-8 weeks and the infection was controlled, bone grafting was performed to repair bone defects in the second-stage operation. Results The flaps survived completely after the first-stage operation in 29 cases. Partial necrosis of the flap occurred in 4 cases and healed after surgical dressing change. All the incisions healed by first intention after the second-stage operation. All patients were followed up 24-32 months (mean, 28 months). All the bone grafts healed after operation, and the radiographic healing time was 3-9 months (mean, 5 months). The clinical healing time was 4-14 months (mean, 8 months). There was no recurrence of osteomyelitis during follow-up. At last follow-up, according to Johner-Wruhs evaluation criteria, the limb function was excellent in 27 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 93.9%. Conclusion For the post-traumatic tibial osteomyelitis with soft tissue defect, the flap combined with induced membrane technique is a reliable and effective method and can effectively restore the function of lower limbs with satisfactory effectiveness.
Objective To investigate the effectiveness of minimally invasive hemi-cortical longitudinal bone transport technique for concurrent treatment of bone and soft tissue defects in patients with tibial osteomyelitis. Methods A retrospective analysis was conducted on 14 patients with tibial osteomyelitis accompanied by bone and skin soft tissue defects, who were admitted between January 2022 and August 2023. There were 10 males and 4 females, with an average age of 51.2 years (range, 35-75 years). Traumatic osteomyelitis was diagnosed in 11 cases, and hematogenous osteomyelitis in 3 cases. The duration of infection ranged from 0.2 to 1.9 months (mean, 1.1 months). All bone defects were rated as Orthopaedic Trauma Association (OTA) type Ⅰ. The length of bone defects ranged from 3.4 to 6.2 cm (mean, 4.8 cm); the width of defects corresponded to 1/4-1/2 of the tibial circumference. The extent of soft tissue defects ranged from 6.5 cm×2.0 cm to 7.0 cm×3.0 cm. Upon admission, primary debridement and antibiotic calcium sulfate bead filling of the medullary cavity were performed, followed by antibiotic-coated bone cement coverage for soft tissue defects. After infection control, secondary minimally invasive tibial osteotomy was performed, followed by Orthofix unilateral external fixator for upper limb use to facilitate bone tissue transport. The time required for external fixation and bone transport was recorded, and wound healing status, bone healing progress, and adjacent joint function were observed. Scoring was performed according to the Paley healing criteria. Results All patients completed two phases of treatment. The external fixation duration ranged from 2.1 to 6.5 months (mean, 4.5 months); bone transport duration ranged from 1.1 to 2.3 months (mean, 1.5 months); external fixation index ranged from 0.6 to 1.3 months/cm (mean, 0.98 months/cm). During bone transport, only 1 patient developed a pin tunnel reaction, with no other complications occurring. All patients were followed up 23-27 months (mean, 25.1 months). All wounds healed, with healing time ranging from 1.1 to 2.6 months (mean, 1.5 months); no infection recurrence was observed during follow-up. Imaging re-examination confirmed complete fracture healing, with healing time ranging from 2.6 to 3.5 months (mean, 3.2 months). At 3 months after discontinuation of bone transport, according to the Paley healing criteria, the bone healing in 14 patients achieved excellent; the joint function was rated as excellent in 11 patients and good in 3 patients. Conclusion The minimally invasive hemi-cortical longitudinal bone transport technique demonstrates satisfactory effectiveness in the concurrent treatment of bone and soft tissue defects following tibial osteomyelitis.