Sequential therapy of VSD and free latissimus dorsi flap for treatment of severe open tibiofibular fractures with bone exposure

LIU Jia-guo; LIU Ying-song; LUO Bin; ZHAO Meng; XUE Sheng-kang; YAN Yong-xiang; XIONG Wei

doi:10.3969/j.issn.1009-4237.2016.02.005

Abstract：Objective To evaluate the surgical technique and clinical significance of the sequential therapy of vacuum sealing drainage ( VSD) and free latissimus dorsi flap in the treatment of severe open fractures of tibia and fibula with bone exposure .Methods From Feb.2002 to Jun.2012,19 cases of Gustilo ⅢB andⅢC open fracture in tibia and fibula , which included large soft-tissue defects and bone exposure ,were treated with the sequential ther-apy of VSD and free latissimus dorsi flap transplantation ,including 13 males and 6 females with an average age of 37.3(17-68) years.Among the patients,11 cases were Gustilo IIIB and 8 cases were Gustilo ⅢC.The bone expo-sure area varied from 16cm ×13cm to 25cm ×17cm.All patients were radically debrided first ,treated with the se-quential therapy of VSD and anti-infective therapy .After the wound was clean without infection ,free latissimus dorsi flap transplantation was conducted for open fractures of tibia and fibula with bone exposure .Results All 19 pa-tents were followed up for 12 to 36 months (average,22 months).The flaps survived in all 19 patients and no infec-tion and vascular crisis happened ,except 2 cases got distal flap tip necrosis ,and healed after debridement and skin graft.Among the patients,13 patients achieved bone healing after 8-21 months;4 patients with tibiar bone defect were treated by autogenous iliac crest bone graft and replaced with plate fixation at 3 months after surgery , and a-chieved bone healing after 9-14 months; at 3 to 6 months after operation ,2 patients with tibial fractures were con-firmed bone loss,bone atrophy and without callus formation by X-ray,and they were treated by autogenous iliac crest bone graft and plate fixation at 6 months after surgery ,and achieved bone healing after 10-13 months.Five patients received a second flap repair and significanlly improved with good appearances .Five patients with flap implantation combined with nerve anastomosis had different degrees of nerve function recovery after surgery . All patients a-chieved normal knee function , 6 patients with tibialis anterior muscle injury had limited ankle dorsi flexion after sur-gery.Conclusion Sequential therapy of VSD and free latissimus dorsi flap transplantation can get good clinical re -sults for the treatment of Gustilo ⅢB and ⅢC open tibiofibular fractures with bone exposure .