Clinical application of bone graft and VSD for the treatment of infectious tibial defect

YANG Guang; ZHAO Guang-xun; HU Feng; WANG Jin; SHI Lei

doi:10.3969/j.issn.1009-4237.2017.06.009

Abstract：Objective To investigate the clinical application of bone graft combined with vacuum sealing drainage(VSD) in the treatment of infectious tibial defect.Methods A total of 11 patients (7 males and 4 females,mean age 37.5 years,range 23 to 62 years) with infectious tibial defect were admitted from Aug.2012 to Jun.2014.All cases were Gustilo type III open tibial fractures with different degrees of soft tissue injury.The injury causes included traffic accident in 8 cases and crushing in 3 cases.Patients were managed with routine debridement,external fixation of fracture and regular follow-up after discharge.Nonunion,bone necrosis,wound exudation and pus occurred repeatedly.The average length of bone defect was (4.5±1.5)cm.Infected bone chips were cleared and VSD material was employed to cover the wound.After the wound was stable,autogenous iliac bone graft plus VSD was used.Finally,appropriate method was chosen to close the wound according to the size of the bone graft and the growth of granulation.Results All patients were followed up for an average of 12 months(6-24months).All had bone union,with an average healing time of 6 months(4-12months).The average time of granulation tissue covering the bone graft area was 18d(15-35 d).Of 11 cases,2 cases were sutured directly in bone graft area,and skin grafting was performed in 3 cases,4 cases were covered with fascia flap,and 2 cases were covered with neurocutaneous flap.All skin grafts and flaps survived well.Conclusion Bone graft combined with VSD has good effect in the treatment of infectious tibial defect,which is relatively simple,can effectively control wound infection and shorten the fracture healing time.