Treatment of severe open leg fractures complicated by bone or/and soft-tissue defects

Objective To investigate managements of severe open leg fractures complicated by bone or/and soft-tissue defects (Gustilo type Ⅲ B/C).Methods Between January 1990 and December 2008,53 patients (37 males and 16 females;aged 17 to 57 years) were treated for severe open leg fractures complicated by bone or/and soft-tissue defects (Gustilo type Ⅲ B:45;Gustilo type ⅢC:8) .The size of soft-tissue defects ranged from 6 cm×4cm to 18 cm ×8 cm.Bone loss occurred in 8 eases.Twenty-five cases were accompanied by head or thoracoabdominal injuries or traumatic shock.The management protocol consisted of primary debridement,bone stabilization (external fixation in 35 patients,simple internal fixation in 16 and bone traction or plaster cast in 2) and second-stage reconstruction of soft tissue defects and/or bone loss by transfer or transplantation of tissue flaps.Fifty-three tissue flaps of 13 types (47 myocutaneous flaps and 6 osteocutaneous flaps) were used to reconstruct the soft-tissue defects and/or bone loss.Results Of the 53 patients,51 were followed up for an average time of 18 months (range:8 months to 9 years).Primary bone union happened in 44 cases and the healing time of bone was 6.5 months (range:3.5 to 9.5 months).Delayed union of bone was found in 4 cases and non-anion in 3,5 of which were handled with bone grafting and 2 of which with bone compression with external fixator.Of the 53 tissue flaps,51 completely survived and the defects were reconstructed successfully.Two flaps necrosed because of vascular thrombosis and infection.The survival rate of flap was 96.2%.No leg amputation was needed in the series.Conclusion Adequate primary debridement,bone stabilization with external fixator or simple internal fixation and staged reconstruction of soft-tissue/bone defects by vascularized tissue flaps are reliable managements for severe open leg fractures complicated by bone or/and soft-tissue defects (Gustilo type Ⅲ B/C). Key words: Tibia;  Fibula;  Fracture,open;  Soft tissue injury;  Treatment