Revision of 120 tibial infected non-unions with bone and soft tissue loss treated with epidermato-fascial osteoplasty according to Umiarov

Redento Mora, Anna MacCabruni, Barbara Bertani, Gabriella Tuvo, Stefano Lucanto, Luisella Pedrotti

Research output: Contribution to journalArticle

Abstract

Treatment of tibial infected non-unions with bone and soft tissue loss has to solve three problems: infection, lack of bone continuity and lack of skin coverage. The aims of treatment are infection healing, bone consolidation with preservation of limb length and soft tissue reconstruction. The most important stage in the planning is an accurate débridement. Soft tissue reconstruction can be achieved using plastic surgery, and bone reconstruction is accomplished with bone grafts or induced membrane technique, but these methods may present disadvantages and risks. Epidermato-fascial osteoplasty is a modified procedure of compression-distraction osteosynthesis that was first described by Umiarov in 1982. This procedure offers the advantages of exactly classifying the phases of simultaneous bone and soft tissue regeneration, and of eliminating large tissue losses without previous closure of soft tissues or use of grafts, because the transported fragment takes fascia and skin along during the transport and closes the edges of the soft tissue gap until the epidermic and fascial reconstruction is complete. A total of 120 patients underwent this kind of surgery between 1986 and 2010 and were followed up for 2-26 years. Average age was 34 years (range 21-57 years). Cultures were positive for Staphylococcus in all cases, and for Pseudomonas in 27 cases. Adequate antibiotic therapy was administered in collaboration with the Infectious Diseases Specialist. Tibial bone resection was from 6 to 18 cm (average 9.5 cm). The Ilizarov apparatus was used with the oblique wire technique for bone transport in all patients. No intraoperative complications were observed. One patient died 40 days after the operation because of pulmonary embolism. The duration of treatment for the remaining 119 patients was 7-18 months. In all cases, infection eradication, healing of regenerate bone, consolidation at the docking site (with the aid of an autoplastic bone graft in only 11 patients), and epidermic and fascial reconstruction were observed, and functional results were very good. These techniques are particularly demanding for the patient and for the surgical team, but our results demonstrate that they can provide excellent outcomes in the management of difficult cases of infected non-unions.

Original languageEnglish
Pages (from-to)383-387
Number of pages5
JournalInjury
Volume45
Issue number2
DOIs
Publication statusPublished - Feb 2014

Fingerprint

Bone and Bones
Transplants
Infection
Bone Wires
Skin
Fascia
Intraoperative Complications
Case Management
Plastic Surgery
Therapeutics
Pseudomonas
Pulmonary Embolism
Staphylococcus
Communicable Diseases
Regeneration
Extremities
Anti-Bacterial Agents
Membranes

Keywords

  • Bone loss
  • Bone regeneration
  • Compression-distraction techniques
  • Infected non-unions
  • Soft tissue loss

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Revision of 120 tibial infected non-unions with bone and soft tissue loss treated with epidermato-fascial osteoplasty according to Umiarov. / Mora, Redento; MacCabruni, Anna; Bertani, Barbara; Tuvo, Gabriella; Lucanto, Stefano; Pedrotti, Luisella.

In: Injury, Vol. 45, No. 2, 02.2014, p. 383-387.

Research output: Contribution to journalArticle

Mora, Redento ; MacCabruni, Anna ; Bertani, Barbara ; Tuvo, Gabriella ; Lucanto, Stefano ; Pedrotti, Luisella. / Revision of 120 tibial infected non-unions with bone and soft tissue loss treated with epidermato-fascial osteoplasty according to Umiarov. In: Injury. 2014 ; Vol. 45, No. 2. pp. 383-387.
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