Vascularized fibular graft combined with vacuum assisted closure in the reconstruction of tibial defects

Abstract

Background: To investigate the application of Flow-through free vascularized fibular graft combined with Vacuum Assisted Closure for the patients suffering from tibial defects caused by chronic osteomyelitis. Methods: We retrospectively analysed 20 cases of patients who accepted this operation in the treatment of tibial defects. Among the tibial defects, six cases resulted from blood stream infection while 14 cases resulted from comminuted fractures. All the patients included in the study were accompanied with 1 to 3 sinuses. The length of the defects ranged from 6cm to 16cm, with an average of 11.3cm. 6 patients were also faced with soft tissues defects combined with tendon or bone exposures, and the defects areas ranged from 11cm×7cm to 19cm×14cm. There were 5 patients suffering from fibular fractures at the same side of the defects. The courses of this disease were 5.5 -15 months, with an average of 9.8 months. Results: The patients included in the study were followed up from 10 months to 4 years, with an average of 1.9 years. Sinuses of 18 patients healed within 4 weeks, giving a primary healing rate of 90%. We undertook debridement of the remaining sinuses and they healed within 2 weeks. All skin flaps grafted to the patients survived, thus the survival rate was 100%. The radiographs indicated that 18 patients had good prognosis and the primary union time of grafting fibula were from 4 to 8 months, with average of 6.3 months. The healing patients achieved an average of 25.6 points based on the Enneking evaluation system which was used to evaluate the function of limbs after the operation, indicating that 85.9% of the limb function recovered. 4 patients required revision surgery for complications resulting from the operation: 1 wound breakdown, 2 bone non-unions, 1 graft fracture. Infection occurred only as a pin-tract infection, and was controlled with oral antibiotics and repeated dressing; there was no deep infection out of control in any of these patients. Conclusion: The flow-through free vascularized fibular graft did not only repair tibial defects, but retained the continuity of trunk vessels. The flow-through fibular graft combined with Vacuum Assisted Closure (VAC) controlled the infection, shortened the course of treatment, and effectively restored limb function when applied to the treatment of tibial defects.