The Combined use of the Ilizarov Method and Microsurgical Techniques for Limb Salvage
Scott T. Hollenbeck, MD, Shoshana L. Woo, BS, Siang Ong, MD, Fitch D. Robert, MD, Detlev Erdmann, MD, L .Scott Levin, MD.
Duke University Medical Center, Durham, NC, USA.
PURPOSE: To review clinical outcomes and propose a new classification scheme for combined use of Ilizarov Method with free tissue transfer for limb salvage.
METHODS: This is an IRB approved retrospective review of 62 patients treated with free tissue transfer and Ilizarov method over the past 15 years at a single institution. The surgical management of these patients is classified into four distinct approaches.
RESULTS: The mean age was 37 years with the most common injury being Gustillo IIIB tibial fractures (61%). Eighty-seven percent of patients had failed prior fixation and 63% had osteomyelitis with a draining wound. The overall flap survival rate was 97%. The mean duration of Ilizarov fixation was 6.9 months with a mean limb length correction of 3 cm. The overall rate of primary bony union was 74%. With a mean follow-up of 42 months, the combined techniques resulted in limb salvage for 84% of cases. Failure of primary bony union was the only predictor of limb amputation.
CONCLUSION: This multidisciplinary approach to limb salvage combines reconstructive microsurgery and the Ilizaroz method.