Closure of the skin defect overlying infected non-union by skin traction.
ABSTRACT Skin traction based on an Ilizarov frame has been used to achieve skin closure in five cases of infected non-union of the tibia including one case of infected knee arthrodesis. Five patients presented with infected non-union of the tibia (all Staph. aureus, two of them MRSA) with overlying sinuses discharging pus at an average 16 months from injury (range 3-36 months). The infections were treated by excision of the sinus and infected skin, excision of the infected non-union, stabilisation of bone with an Ilizarov circular frame and either acute shortening with compression followed by distraction (3 patients), or bone transport (2 patients). After excision of the sinus, the skin defect was gradually closed using a skin traction device placed on an Ilizarov circular frame. The size of the wounds ranged from 5 x 14 cm to 3 x 5 cm and skin traction was completed at 4 weeks (range 2-8 weeks). When the wound edges were approximated, the wires were left in place until healthy granulation tissue built up to seal the remaining gap (sutures were used in two patients). At follow-up assessment at 18 months (range 7-24 months), all non-union were solidly united with no signs of infection of either the bone or underlying skin. The quality of skin at the stretching site was found to be of normal sensation, colour, mobility but thinner than normal. The quality of the skin at the docking site (left to granulate) was found to be adherent to the underlying bone, red or pink in colour, hypersensitive in 2 patients and numb in 3 patients.
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ABSTRACT: The authors report the case of a 28-year old male who presented with a compound diaphyseal fracture of the tibia, which was treated with intramedullary nailing. Postoperatively he required an extensive fasciotomy for an acute compartment syndrome. The fracture evolved towards post-traumatic osteomyelitis, growing methicillin-resistant Staphylococcus aureus (MRSA), combined with a large overlying soft tissue gap. An Ilizarov frame was used to treat both the bone and the skin defect. The infected fracture was treated by resection and longitudinal bone transport. Meanwhile, the skin was gradually closed using extra rods on the frame, allowing for a transverse 'skin transport'. Both the bone and the soft tissues healed without further complications.Acta orthopaedica Belgica 05/2006; 72(2):214-8. · 0.40 Impact Factor
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ABSTRACT: The purpose of this article is to describe the use of shortening and angulation to manage composite bone and soft tissue loss associated with combat-related type IIIB open tibia fractures. Four patients underwent placement of a software-driven circular fixator with acute shortening and angulation to manage composite bone and soft tissue loss. Frames were applied using the Rings First Method, and an induced deformity was created with the soft tissue defect within the concavity. Distraction histiogenesis was utilized to restore limb length and regenerate soft tissues. Three patients had healed fractures and mature regenerate allowing frame removal, while one remained in his frame for further consolidation. Mechanical alignment and limb length were restored in all patients. No major frame adjustments were required and all distracted soft tissues healed without complication. The article concludes that composite bone and soft tissue loss is effectively managed with distraction histiogenesis and the use of a software-driven circular fixator.Journal of surgical orthopaedic advances 01/2010; 19(1):23-8.