| ObjectiveTo discuss the efficacy of the treatment on tibia traumatic osteomyelitis with skin and soft tissue defect using vacuum sealing drainage(VSD) combined with open bone graft or bone transportation.MethodsA retrospective analysis was made on 24 patients with tibia traumatic osteomyelitis from January 2012 to June 2013,with 16 Male cases and 8 female cases, age from 22 to 66 years. The average age of 41.5 years.All the patients’ wounds received bacterial culture as well as drug sensitivity test, X ray examination and three-dimensional CT reconstruction preoperatively. The length of tibia bone defects after debridement were ranging from 2-9(5.96±2.14)cm, with the wound area ranging from 3×3 to 9×7(25.63±17.44)cm2. 5 patients who had bone defect less than 4cm were treated with debridement, together with open bone graft and VSD. Debridement, together with bone drainage combined with open bone graft or bone transportation transportation, and VSD were performed in the other 19 patients who had bone defect more than 4cm.ResultsAll the patient were followed up for 13.3 months on average, ranging from 10-18 months. Antibiotic treatment was performed for 7.9 days on average(ranging 5 to 14 days) and VSD was performed for 2.9 times on average(ranging 0 to 10 times). The wounds of 2 cases were directly sutured after debridement,the other were healed.19 cases had bone healing within 6.4 months on average(ranging 3 to 15 months). The other 5 patients developed nonunion after bone transportation treatment together. However, they had achieved bone healing with a second operation, including debridement of the incarcerated soft tissue, marrow antrum perforation,autologous iliac bone graft and VSD. Only 2 patients had pin track infection and were treated successfully with antibiotics. Follow up the area of soft tissue defects after the operation for 1,2 months, it was found that it was significantly improved compared with preoperation.(P<0.05). According to the Paley fracture healing score standard, 19 cases were excellent, 3 were good,2 was were and 0 was poor.The good rate was 91.6%.ConclusionsVSD combined with open bone graft or bone transportation is an effective strategy for tibia traumatic osteomyelitis with soft tissue defect.drainage combined with open bone graft or bone transportation... |
