Reconstruction of massive tibial bone and soft-tissue defects by trifocal bone transport combined with soft-tissue transport: experience from 31 cases

Abstract

Background The study was designed to investigate the safety and efficacy of trifocal bone transport (TFT) and soft-tissue transport with the Ilizarov technique for large posttraumatic tibial bone and soft tissue defects. Methods We retrospectively reviewed 31 patients with massive posttraumatic tibial bone and soft tissue defects from May 2009 to May 2016. All of the eligible patients were managed by TFT and soft-tissue transport. The median age was 33.4 years (range, 2-58 years). The mean defect of bone was 11.87cm ± 2.78cm (range, 8.2-18.2cm) after radical resection performed by TFT. The soft tissue defects ranged from 7cm x 8cm to 24cm x 12cm. The observed results included bone union time, wound close time and true complications. The Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system was used to assess bone and functional results and postoperative complications were evaluated by Paley classification. Results The mean duration of follow-up after frame removal was 32 months (range, 12-96 months). All cases achieved complete union in both the elongation sites and the docking sites, and eradication of infection. The mean bone transport time was 94.04 ± 23.33 days (range, 63.7-147 days). The mean external fixation time was 22.74 ± 6.82 months (range, 14-37 months), and the mean external fixation index (EFI) was 1.91 ± 0.3 months/cm (range, 1.2–2.5 months/cm). The bone results were excellent in 6 patients, good in 14 patients, fair in 8 patients and poor in 3 patients. The functional results were excellent in 8 patients, good in 15 patients, fair in 5 patients and poor in 3 patients. Conclusion The TFT in concert with soft-tissue transport technique can be used successfully to manage large tibial bone and soft-tissue defects. Soft-tissue transport can offer a feasible method for the defects with good soft tissue coverage on the bone ends. However, imprecision in the series results precludes a definitive conclusion, and comparative study is needed to assess whether soft-tissue transport is more effective than flap transfer for such soft-tissue defect.

Correction to: Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction: experience from 31 cases

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