Trifocal versus bifocal bone transport in treatment of long segmental tibial bone defects

Catagni, Maurizio A.; Azzam, Wael; Guerreschi, Francesco; Lovisetti, Luigi; Poli, Piero; Khan, Muhammad Shahid; Giacomo, Lorenzo Maria Di

doi:10.1302/0301-620x.101b2.bjj-2018-0340.r2

Cited by 63 publications

(80 citation statements)

References 24 publications

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“…Paley et al [21] stated that bone transport beneath the ap seemed to proceed more easily than in closed defects with scarred soft tissues and ap coverage may contribute to docking site union without grafting. The mean EFI in this series was 1.91 ± 0.3 months/cm, inferior to that reported by recent research studies on bone transport and ap technique [10,11]. In addition, this technique is only suitable for the cases with both ends with good soft-tissue coverage and without bone exposure after debridement.…”

Section: Discussioncontrasting

confidence: 82%

“…However, bifocal bone transport (BFT), which is regarded as a simple-level osteotomy bone transport, has the disadvantages of long frame duration, poor regenerates, and frequent complications. In recent decades, some scholars proposed the concept of TFT, which is also called double level osteotomy bone transport, and is strictly only suitable for bone defects over or equal to 8cm [10,11]. At present, there are few clinical reports about this technique.…”

Section: Introductionmentioning

confidence: 99%

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

Fan

et al. 2020

Preprint

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Background Large post-traumatic tibial bone defects combined with soft tissue defects are a common orthopedic clinical problem associated with poor outcomes when treated using traditional surgical methods. 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: TFT, in conjunction with soft tissue transport technique, can give good results in most patients (in this article, good and excellent results were observed in 64% of patients). Soft tissue transport is a feasible method in providing good soft tissue coverage on the bone ends. Although it has no advantages over microvascular techniques, it might be an good alternative in the absence of an experienced flap surgeon. Nonetheless, high-quality controlled studies are needed to assess its long-term safety and efficacy.

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Section: Discussioncontrasting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

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

Fan

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Paley et al [19] stated that bone transport beneath the ap seemed to proceed more easily than in closed defects with scarred soft tissues and ap coverage may contribute to docking site union without grafting. The mean EFI in this series was 1.91 ± 0.3 months/cm, inferior to that reported by recent research studies on bone transport and ap technique [10,11]. In addition, this technique is only suitable for the cases with bilateral ends of the bone defects with good soft-tissue coverage and without bone exposure after debridement.…”

Section: Discussioncontrasting

confidence: 80%

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

Fan

et al. 2020

Preprint

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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.

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“…An ideal osteotomy technique is one that minimizes soft tissue and periosteal disruption, lessens thermal necrosis, and produces high-quality healing tissue [1]. These goals can be accomplished with a technique that is truly minimally invasive and preserves the medullary, as well as periosteal blood supply [3][4].…”

Section: Introductionmentioning

confidence: 99%

“…Currently, multiple drill-hole (MDH) and Gigli saw osteotomy are the two foremost methods for osteotomy, being favoured and recommended by many orthopedic surgeons [3][4][5][6]. Recently, several studies have evaluated their outcome and reported the best results for quality of the regenerated bone in comparison with other methods of osteotomy [2,7].…”

Section: Introductionmentioning

confidence: 99%

Ilizarov External Fixation: Percutaneous Gigli Saw Versus Multiple Drill-hole Osteotomy Techniques for Distraction Osteogenesis

Makhdoom

Kumar

Siddiqui

2019

Cureus

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Introduction Many different methods and variations have been employed to perform osteotomy for deformity correction, bone lengthening, and segmental bone transport. Currently, multiple drill-hole (MDH) and Gigli saw osteotomies are the two most preferred ones, being favoured over other techniques. Our objective is to compare the modified healing index (mHI) of these two commonly used procedures. Methodology This retrospective study was conducted at the department of Orthopedics, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan. The study population consisted of all skeletally mature patients who underwent tibial bone osteotomy for bone lengthening or bone transport using Ilizarov circular fixator from June 2016 to September 2018. We excluded patients with metabolic bone disease and patients who underwent osteotomy for deformity correction. Preoperative and operative patients’ demographics and clinical data were gathered through a review of medical record and mHI was calculated to compare the effectiveness of osteotomy techniques. Results A total of 50 patients, 74% males and 26% females 26% with a mean age of 33.14 ± 12 years were included in the study. Of the 50 patients, 23 (27 osteotomies) had undergone MDH osteotomy (group I), whereas 27 patients (37 osteotomies) had a Gigli saw osteotomy (group II). The overall mHI of both groups was 1.60 ± 0.34 month/cm (range 1.0-2.5 month/cm). When we compared the mHI of both techniques, the mean mHI was 1.72 ± 0.33 month/cm (range 1.2 - 2.5 months/cm) in MDH group and 1.54 ± 0.36 month/cm (range 1.0-2.5 month/cm) in the Gigli saw group. The healing index was significantly lower in the Gigli saw group. None of our patients showed nonunion at the osteotomy site. However, the problems of incomplete osteotomy in two cases and bone fractures in four cases were seen in MDH osteotomy. Conclusion According to our results, percutaneous Gigli saw osteotomy technique by two small incisions minimizes the local soft tissue trauma and periosteal disruption around the osteotomy more than the multiple drill holes osteotomy, resulting in better consolidation following distraction osteogenesis.

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Trifocal versus bifocal bone transport in treatment of long segmental tibial bone defects

Cited by 63 publications

References 24 publications

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

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

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

Ilizarov External Fixation: Percutaneous Gigli Saw Versus Multiple Drill-hole Osteotomy Techniques for Distraction Osteogenesis

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