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Free bone retention plus iliac bone grafting under phase I vacuum sealing drainage lavage for treatment of Gustilo type I, II, and IIIA open bone defects

Leigang Yang, Yungang Yang, Xiuming Yang, Tianxu Yang, Yuxuan Yang, Junjie Xie

This study aimed to investigate the treatment efficacy of free bone retention plus iliac bone grafting under phase I Vacuum Sealing Drainage (VAS) lavage for treatment of open bone defects. Thirty-six bone fractures were classified according to the Gustilo classification between January 2008 and April 2016. This study included 16 type I cases, 12 type II cases, and 8 type IIIA cases. Length of the longitudinal section of the damaged free crushed bone was 0.5 to 7.1 cm. There were 7 cases with sections ≤ l cm, 12 with sections 2 to 3 cm, 11 with sections 3 to 5 cm, and 6 with sections>5 cm. The rinse protocol comprised 3000 ml/d of saline for 3 days for Gustilo type I fractures, 6000 ml/day of saline for 5 days for Gustilo type II fractures, and 9000 ml/d of saline for 7 days for Gustilo type IIIA fractures. Fifty ml of Anerdian (type III, diluted 10 fold) was added by VSD treatment (closed negative-pressure lavage). Callus formation was seen within 3.5 months after surgery, with osseous union at an average of 6.5 months. The wound healed well in 35 cases. In l case, the patient developed superficial cellulitis near the screw path, which resolved after removing the external fixation device. There was no internal fixation loosening, breakage, or exposure. Non-union and osteomyelitis were not seen. This method could be effective to prevent infection, osteomyelitis, delayed union, and non-union.