Elimination of an extensive femoral soft-tissue defect using dermotension according to the Ilizarov technology

Martel' I.I., Grebeniuk L.A., Dolganova T.I.

Abstract


The authors present a clinical case of a successful surgical treatment of a soft-tissue defect in a female patient with pelvic bone fractures and a severe extensive defect of the femoral soft tissues by using traction appliances fixed to the Ilizarov fixator. The method of transosseous osteosynthesis was used for treatment. Secondary sutures were applied after soft tissue necrectomy and the ligature ends were fixed to the mentioned traction appliances. Optimal rate and rhythm of distraction was produced in the process of dermotension. The traction of the wound ends towards each other started on the second day after surgery with the rate of 0.5 mm 6–8 times a day and continued 15 days. A 30-cm long juxtaposition of the wound edges was achieved. It enabled to use interrupted sutures. The integumentary tissue defect of the area over 1500 cm2 was eliminated. The remaining wound areas that measured 5.0 cm × 10.0 cm and 8.0 cm × 12.0 cm in size were eliminated using the Tyrš dermoplasty. The patient’s skin biomechanical condition was evaluated by acoustic velocimetry in order to prevent skin overstretching. Microcirculation of tissues in the wound and that of the stretched skin was controlled by ultrasound high-frequency Dopplerography. The healing of the wound soft-tissue defect using graduated dermotension is associated with redistribution of stresses in the integumentary tissue and with formation of its new mechano-biological status. Indirect signs of skin overstretching near the wound edges were not revealed. Three types of blood flow in the wound tissue were recorded with ultrasound Dopplerography: microcirculatory, arterial, and venous with a clear respiratory wave. The calculated index of differences near the wound edge and in the wound soft tissues varied from 5.0 to 23.0 relative units that is typical for an active granulation process. Good anatomic and functional results were achieved clinically. Static and locomotor functions of the lower limb recovered completely. The patient was satisfied with the cosmetic and functional results. The technique of dermotension using the Ilizarov fixator was used at the Center’s clinic in 19 patients with open fractures of long bones that were accompanied with soft tissue defects of various sizes.

Keywords


dermotension, soft-tissue defect, wounds, femur, the Ilizarov technology, mechano-acoustic anisotropy, skin, microcirculation

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