Charles E. Dumont, MD, PhD
Swiss and French Boards Certification in Orthopaedic Surgery and Traumatology Swiss and French Boards Certification in Hand Surgery
Both infected bone and soft tissue have been removed, the bone bridged with antibiotic-impregnated cement, the missing soft tissue replaced with a free vascularized tissue transfer and a thin skin graft and the bone stabilized with an external fixation.
X-rays of the leg 6 months after the open fracture. The bone is not healed and severely infected (infected nonunion)
This 57 years old woman had an open fracture of the tibia 6 months ago and was already operated on 4 times at the time she was referred to us. The fracture did not heal and both bone and soft tissue are severely infected. The tibia is infected and necrotic over several centimeters. The staged reconstruction required to achieve complete healing is consisting of (1) removing all infected tissues, (2) temporary bridging of the bone with antibiotic-impregnated cement, (3) bone stabilisation with external fixation and (4) covering the bone and cement with a tissue transfer harvested on the patient’s shoulder. Following several weeks with general antibiotics the cement can be removed and the bone reconstructed with a bone autograft (iliac crest cancellous bone). At 8 months follow-up was the fracture is healed without infection recurrence. The patient can ride horses again.
General antibiotics were given for several weeks. Subsequently the bone was reconstructed with a bone autograft harvested on patient’s iliac crests. The external fixation was removed after complete bone healing and full weight bearing allowed.
The reconstructive surgery is a surgical specialty at the edge of both the orthopaedic and plastic surgeries. The main topic of this surgery is the biological reconstruction of injured or missing soft tissue and bone in extremities.
It is based on tissue transfer harvested on other body locations (auto-transfers). Obtaining a stable skeleton, well blood supplied soft tissue and joints with good range of motion are the main goals of the reconstructive surgery. This can be achieved sometime through simple, single surgery but more complex situation may require sophisticated surgeries in one- or two-stage, as it is showed in the following clinical situation:
Two-stage reconstruction in infected nonunion of the tibia