Review of soft tissue coverage options in distraction osteogenesis of the extremity

• 作者: Anna C. Howell Beina Azadgoli Douglass Tucker Geoffrey Marecek Jacqueline Stoneburner Joseph Carey
• 来源期刊: 整形与美容研究（英文版）
• 年，卷（期）: 2020,（3）
• 页码范围: 23-40
• 页数: 18页
• 语种: 英文
• DOI: 10.20517/2347-9264.2019.028

摘要

Aim: To review the choices of soft tissue coverage in distraction osteogenesis of the extremity. Methods: A PubMed literature search yielded 14 articles included for systematic review. Data were extracted from each article if available (sample size, patient age, surgical indications, type of flap, use of additional modalities, method of bone osteogenesis, postoperative events, follow-up, satisfaction, weight-bearing status, and success rate). Unpaired t-tests were performed to compare complication rates. A retrospective review of three cases was also conducted. Results: Fourteen articles discussed 145 patients with a mean age of 33.4 years and 146 extremity injuries followed over 3.3 years on average. Indications included chronic osteomyelitis or nonunion (58.2％) and acute trauma (41.8％). Average time from injury was 1.1 years. Ilizarov frame was used in 12 articles. Free flaps (88.0％) or rotational flaps (12.0％) were used, with muscle flaps (96.7％) being most common. Most extremities received free latissimus dorsi or rectus abdominis flaps. Bone grafts and antibiotic beads were often used in conjunction. Although complications and reoperations were not uncommon (up to 30％), 98.8％ of patients on average were ultimately weight bearing and all articles reported > 91％ success rate. Additionally, the rates of any complication were not statistically different between "fix and flap" protocol and flap or frame first. Lastly, a three-patient case series is presented. Conclusion: Bone transport with soft tissue reconstruction remains an excellent choice for patients with large bony defects or who are unable to undergo autologous bone grafting. Not one surgical approach to limb salvage is superior, and decision should be made on a case by case basis between the surgeon and the patient.