To Compare Treatment Result Of Combined Open Bone Grafting With Vacuum Sealing Drainage(VSD) And Traditional Open Bone Grafting For Posttraumatic Infected Bone Defect Of The Tibia

Objective:The management of bone defects caused by trauma andnonunion continues to represent a substantial clinical challenge in orthopaedictrauma. Their management requirescareful consideration of patient factors(age, presence ofchronic disease, nutritional status, smoking), state of thesofttissues and blood supply surrounding the defect as well as thelocation andextent of the bony defect. A ‘‘critical-sized defect’’ is generally regarded asone that would not healspontaneously despite surgical stabilization andrequiresfurther intervention such as autologous bone grafting. Whatconstitutes a ‘‘critical-sized defect’’ varies with the anatomiclocation of thedefect as well as the state of the soft tissuessurrounding it.The relative rarity ofthese injuries means that a high level evidence to guide their management issparse. As such, effective management of bone defects requires anunderstanding of the available evidence as well as consideration of patient andsurgeonfactors.Compare the clinical result of infected bone defects of the tibia treatedwith combined open bone graft with vacuum sealing drainage(VSD) andtraditional open bone graft.Methods:From January2009to November2012,15cases ofposttraumatic infected bone defect of the tibia were treated in our traumacenter.They were13males and2females,with a average of30years(rang,21-57).The location of the bone defect involved proximal tibia in7cases,middle in2and distal in6.The range of bone defect was1.5-8cm(average3.1cm).The procedure included aggresssive excisionaldebridement of infected or necrotic bone,open bone grafting with cancellous autograft,wound closure by secondary intent with or without vacuum sealingdrainage,and prenention of infection with concomitant parenteralantibiotics.All cases were divided into two groups depending on the differentmethods of wound management following the bone grafting.Group A,theVSD was applied to wound at the end of each surgical debridement,andcontinued after open bone grafting until the grafted bone was covered withgranulation tissue completely. Group B,the wound was left open withconventional dressing.The time from last debridement until bone grafting,from bone grafting until the grafted bone was covered by granulation tissue,the time of wound healing and bone defect healing were recorded.Results:The follow-up period was13~25months,average15months.Thegrafted bone were fully covered through spontaneous epidermialization fromthe wound edge in11cases.The split-thickness skin grafting was necessary fora large wound area in4cases from both groups.The pin site infection wasoccured in3cases in group A and4cases in group B.All cases achived boneunion in the period of4.5-11months,average8months.There were significantdifferences between the time from last debridement until bone grafting,frombone grafting until the grafted bone was covered by granulation tissue, thetime of wound healing and bone defect healing,and was no significantdifference in time of bone union of tibial defect in group A and group B.Conclusions:The combined open bone grafting with vaccum sealingdrainage can significantly improve the healing of bone grafting zone,andshorten the interval of hospitalization,but may not reduce the healing time ofbone defect of the tibia.The relative rarity of these injuries means that suchinvestigation will need to use largescale, multicenter trials.