Tibial periosteum flap combined with autologous bone grafting in the treatment of Gustilo-IIIB/IIIC open tibial fractures.

Purpose: Gustilo IIIB/C injuries are common for tibia diaphysis fractures with high rates of nonunion, osteomyelitis, and amputation. However, the managements on tibial Gustilo IIIB/C injuries are still controversial and individual. The aim of this study is to introduce the tibial periosteum flap combined with autologous bone grafting to treat Gustilo-IIIB/IIIC injuries.

Methods: Sixteen Gustilo type IIIB/C tibial fracture patients who underwent tibial periosteum flaps with autologous bone grafting surgeries were retrospectively studied. In the first stage, the wound was treated with debridement and the fracture was reduced and fixed with an external fixator. After covering with vacuum sealing drainage for 7 days, the wound areas were repaired by flaps. When the flaps survived and external fixators were removed, the tibial periosteum flaps were taken with autologous bone grafting for bone defects.

Results: The tibia fractures were comminuted fractures with mean size of segment bone defects 3.1 ± 1.3 cm. All the flaps survived and the wound healed in the first stage after an average of 1.5 ± 0.6 months. The mean size of the flap was 13.2 ± 2.8 cm × 7.3 ± 3.1 cm. All the autografts healed in 4.5 ± 0.7 months without infection and malunion. There was no pain in the affected limb. The weight-bearing and walking function were restored.

Conclusion: Tibial periosteum flap combined with autologous bone grafting is effective to treat bone-skin defect of leg with Gustilo-IIIB/IIIC injury.