Long-Term Results and Costs of Muscle Flap Coverage With Ilizarov Bone Transport in Lower Limb Salvage
Long-Term Results and Costs of Muscle Flap Coverage With Ilizarov Bone Transport in Lower Limb Salvage
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DOI：
10.1097/bot.0b013e31828afde4
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发表时间：
2013-10-01
影响因子：
2.3
通讯作者：
Parrett, Brian M.
中科院分区：
文献类型：
--
作者：
Lowenberg, David W.;Buntic, Rudolf F.;Parrett, Brian M.
目的：探讨Ilizarov骨移植和皮瓣移植保肢的远期疗效和成本。设计：病例系列，随访至少6年。地点：学术三级医疗中心。患者：从1993年到2005年，连续34例建议截肢但行复杂保肢手术的创伤性下肢创伤和胫骨缺损患者。干预：皮瓣重建和Ilizarov骨移植。主要观察指标：皮瓣并发症、感染、愈合、畸形愈合、是否需要慢性麻醉剂、步行状况、就业状况和是否需要再次手术。结果：34例患者平均年龄40岁，其中急性Gustilo IIIB/C缺损者14例，慢性胫骨缺损者20例(伴骨髓炎的骨不连)。肌瓣修复35例，皮瓣丢失1例(2.9%)。平均胫骨缺损8.7 cm，平均骨转移时间10.8个月，平均随访11年。骨不连发生率为8.8%，畸形愈合率为5.9%。所有患者均获得最终愈合，无复发骨髓炎病例。没有患者接受未来的截肢手术，29%的患者需要再次手术，97%的患者在没有帮助的情况下行走，85%的患者全职工作，只有5.9%的患者需要慢性麻醉剂。结论：骨运输和皮瓣覆盖的长期结果和成本在这一人群中支持复杂的肢体保留术。
Objectives:To determine long-term outcomes and costs of Ilizarov bone transport and flap coverage for lower limb salvage.Design:Case series with retrospective review of outcomes with at least 6-year follow-up.Setting:Academic tertiary care medical center.Patients:Thirty-four consecutive patients with traumatic lower extremity wounds and tibial defects who were recommended amputation but instead underwent complex limb salvage from 1993 to 2005.Intervention:Flap reconstruction and Ilizarov bone transport.Main Outcome Measurements:Outcomes assessed were flap complications, infection, union, malunion, need for chronic narcotics, ambulation status, employment status, and need for reoperations. A cost analysis was performed comparing this treatment modality to amputation.Results:Thirty-four patients (mean age: 40 years) were included with 14 acute Gustilo IIIB/C defects and 20 chronic tibial defects (nonunion with osteomyelitis). Thirty-five muscle flaps were performed with 1 flap loss (2.9%). The mean tibial bone defect was 8.7 cm, mean duration of bone transport was 10.8 months, and mean follow-up was 11 years. Primary nonunion rate at the docking site was 8.8% and malunion rate was 5.9%. All patients achieved final union with no cases of recurrent osteomyelitis. No patients underwent future amputations, 29% required reoperations, 97% were ambulating without assistance, 85% were working full time, and only 5.9% required chronic narcotics. Mean lifetime cost per patient per year after limb salvage was significantly less than the published cost for amputation.Conclusions:The long-term results and costs of bone transport and flap coverage strongly support complex limb salvage in this patient population.