[Free iliac flap grafting for repair of tibia traumatic osteomyelitis complicated with bone-skin defect].

OBJECTIVE: To investigate the method and clinical effect of free iliac flap grafting in repairing the tibia traumatic osteomyelitis complicated with bone-skin defect.

METHODS: From June 2001 to February 2006, 28 patients with tibia traumatic osteomyelitis complicated with bone-skin defect were treated with free iliac flap grafting at stage I. There were 18 males and 10 females, with an average of 32.5 years(18-68 years). There were traffic injury in 11 cases, bruise in 6 cases, explosive injury in 5 cases, machinery injury in 4 cases, and falling injury in 2 cases. The disease courses of patients were 1-6 months. All patients had been treated by 2-6 operations. The wounds located at the mid and upper tibia in 13 cases, and the inferior tibia in 15 cases. The length of free iliac was 0.5-6.0 cm and the size of the flap ranged from 4.5 cm x 3.5 cm to 28.0 cm x 16.0 cm. The external fixation were applied in 18 cases, and steel plate were applied in 10 cases. The donor sites were sutured directly.

RESULTS: All of the flaps survived completely. The wounds healed by first intention in 26 cases and by second intention in 2 cases. The donor sites healed by first intention. Twenty-eight patients were followed up for 6 to 56 months (mean, 30 months). The appearances of the flaps were satisfactory and the colour was similar to recipient site. All grafted bone united 2-14 months (mean, 4.6 months) after operation according to X-ray examination. In 20 patients who did not achieved union before operation, fracture healed 2 to 6 months after operation(mean, 3.2 months). Osteomyelitis recurred 12 months after operation in 2 cases and healed by nidus clearing.

CONCLUSION: Free iliac flap which used to repair tibia traumatic osteomyelitis complicated with bone-skin defect, can repair the defect at stage I and enhance the anti-infectious ability. It is one of appropriate and effective clinical methods.