Effects of 1-stage revascularization and temporary external fixation combined with 2-stage Ilizarov technique in the treatment of bone defects in lower limb destruction injury: A case report.

Rationale: To evaluate the clinical effects of 1-stage revascularization, vacuum sealing drainage covering the wound, temporary external fixation and 2-stage Ilizarov bone transport for the treatment limb destruction injury.

Patient Concerns And Diagnosis: Nine patients with limb destruction injury between September 2014 and June 2019 at our institute were evaluated retrospectively. The age of patient was 21 to 51 years with an average of 33 years. The injuries were caused by vehicle accidents in 4 patients, gunshot in 1 patient, and crushing injuries in 4 patients. All of them had vascular injury. The average length of bone defect was 9.5 (8.3-10) cm. Regular follow-up was performed on wound healing, bone transport time, bone healing time, external fixation index, and limb function.

Interventions: All patients underwent 1-stage revascularization and temporary external fixation during emergency surgery, and then gradual bone transport by Ilizarov fixator was performed until the broken fracture site was reunited.

Outcomes: Nine patients were followed up for 12 to 48 months (average 30 months). Six patients were treated with autogenous cancellous bone graft for the second time, and 2 patients healed spontaneously. The mean wound healing time was 86 (73-90) days. The bone transport time was 97 (88.3-105.3) days, and the bone mineralization time was 164.5 (156.8-181.3) days, and the healing time of the docking sites was 6.8 (6.1-8.3) months. The external fixator time was 14.5 (12.5-17) months with the external fixation index was 1.5 (1.4-1.8) m/cm. At the last follow-up, according to the Association for the Study of the Method of Ilizarov functional scores, excellent functional outcomes were obtained in 5 patients, good in 1 patients, moderate in 2 patients. According to the Association for the Study of the Method of Ilizarov Radiological System, excellent functional outcomes were obtained in 6 cases and good in 2 cases.

Lessons: One-stage revascularization and temporary external fixation combined with 2-stage Ilizarov bone transport technique for the treatment of bone defects in limb destruction injury have satisfactory clinical effects and few complications, and can be applied under the condition of strict understanding of surgical indications.