“Primary free-flap tibial open fracture reconstruction with the Masquelet technique” and internal fixation

Abstract

Background:Grade III open fractures of the lower extremity are serious injuries and are difficult to reconstruct. The optimal treatment for such injuries is unclear. We aimed to determine the safety and efficacy of orthoplastic reconstruction, using a primary free anterolateral thigh flap combined with the Masquelet technique and internal fixation for Gustilo grade IIIB/C open tibial fractures.Methods: From April 2018 to April 2019, 15 patients, ranging from 19 to 72 years old, with Gustilo grade IIIB/C open fractures were treated using a primary free anterolateral thigh flap combined with the Masquelet technique and internal fixation. This involved wound debridement and removal of free bone fragments, followed by bone cement packing of the defect, external fixation, and vacuum sealing drainage treatment. The final stage involved switching from external to internal fixation and wound repair using a free anterolateral thigh flap. Repair time ranged from 2 to 7 days. Flap size ranged from 25 × 15 cm 2 to 13 × 7cm 2 . Hospital stay ranged from 11 to 50 days (mean, approximately 33.3 days). Bone cement was removed after 6-19 weeks and replaced with autogenic cancellous bone.Results: All flaps survived without incident. One patient experienced a wound infection, but there were no deep infections. For all patients, bone union was achieved after 4 to 7 months. Conclusion:The use of a primary free anterolateral thigh flap combined with the Masquelet technique and internal fixation is a safe and effective procedure for reconstruction of Gustilo grade IIIB/C open fractures.

Comparison of the clinical outcomes between vascularized bone graft and the Masquelet technique for the reconstruction of Gustilo type III open tibial fractures

“…The average union time was 13.5 months measured from the second stage of the MT to radiographic union. Kang et al revealed that the union time ranged from 4 to 7 months after the second stage of the surgery [ 20 ]. The union time was shorter than that reported by Zoller and the present study.…”

Analysis of the Risk Factors for Free Flap Necrosis in Soft Tissue Reconstruction of the Lower Limbs

“…The utility model had the advantages of fewer operations, shorter treatment cycles, rapid functional recovery, and satisfactory clinical outcomes. 43,44 We believe that the advantages of emergency microsurgical repairs are significant. First, it prevents persistent ischemic necrosis in some tissues.…”

Decellularized vascularized bone grafts: A preliminary in vitro porcine model for bioengineered transplantable bone shafts

“…Reconstructions remain a challenge despite the availability of various technical options and bone substitutes in current surgical practice ( Balogh et al, 2012 ). Indeed, these reconstructions can be handled in different ways, depending on location, etiology, and patient’s condition, as follows: conventional techniques including autologous bone grafts ( Sun et al, 2019 ), prosthetic surgery ( Ogura et al, 2018 ; Jamshidi et al, 2020 ), peri-implant membrane induction with secondary grafting ( Masquelet and Begue, 2010 ; Giannoudis et al, 2016 ; Sivakumar et al, 2016 ), reconstructive microsurgery ( Pederson and Grome, 2019 ; Bibbo, 2021 ), distraction osteogenesis ( Lesensky and Prince, 2017 ), or a combination of these ( Niu et al, 2011 ; Houben et al, 2019 ; Kang et al, 2020 ). However, all procedures are associated with several disadvantages.…”