Chinese Journal of Tissue Engineering Research ›› 2020, Vol. 24 ›› Issue (26): 4208-4212.doi: 10.3969/j.issn.2095-4344.2767

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Prefabricated composite tissue flaps for repairing bone and soft tissue defects of the extremities

Wang Zhenggang, Liu Mingjiang, Huang Xinfeng, Xiao Xiangjun   

  1. Department of Traumatic Orthopedics, Affiliated Nanhua Hospital, University of South China, Hengyang 421002, Hunan Province, China

  • Received:2019-09-24 Revised:2019-09-29 Accepted:2020-02-11 Online:2020-09-18 Published:2020-09-02
  • About author:Wang Zhenggang, Master, Attending physician, Department of Traumatic Orthopedics, Affiliated Nanhua Hospital, University of South China, Hengyang 421002, Hunan Province, China
  • Supported by:

    the Scientific Research Project of Hunan Provincial Health and Family Planning Commission, No. A2017018

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Abstract:

BACKGROUND: Prefabricated composite tissue flaps have been used by Bakamjjan for cardiac repair since 1973, but have not been widely used due to technique limitations. Domestic research on prefabricated composite tissue flaps to repair limb bones is rarely reported.

OBJECTIVE: To analyze the effects of prefabricated composite tissue flaps in the repair of limb bone and corresponding soft tissue defects.

METHODS: New Zealand big rabbit models of bone fracture and soft tissue defect of the extremities were constructed (first operation) and randomly divided into three groups. In group A, prefabricated composite tissue flap was used to treat bone and soft tissue defects of the extremities at 10 days after modeling (second operation). In group B, free femur was used to treat bone and soft tissue defects of the extremities at 10 days after modeling. In group C, the incision was open and sutured with no treatment. General condition, body weight, imaging finding and histological findings were compared between groups.

RESULTS AND CONCLUSION: There was 100% survival in all the three groups. Graft displacement was observed in 2 rabbits in the group B, but the deformity healed, which had little effect on the rabbit's mobility. The weight recovery and gain were higher in the group A than in the group B (P < 0.05). The imaging findings showed that a large number of calluses were formed in the group A at 2 weeks after operation, which were bridged in gap at 4 weeks after operation, filled in the defect gap at 8 weeks, and remodeled at 12 weeks. In the group B, a small amount of calluses were formed at 2 weeks after operation, and began to increase at 4 weeks. The femoral cut was obvious. A large number of calluses were formed at 8 weeks after operation, and the defect gap was filled at 12 weeks after operation. In the group C, the callus began to form at 8 weeks after operation, and the defect gap was still present, with osteosclerosis at the two ends. The Lane-Sandhu score was statistically different between the three groups at 8 and 12 weeks after second operation (P < 0.05). Histological observation indicated that a large number of newly formed osteoblasts and bone cells were formed in the group A at 4 weeks after operation, and the tubular structure increased and irregular bone island formed at 8 weeks; new bone formed at 12 weeks, with the presence of the medullary cavity containing yellow bone marrow dominated by adipocytes. In the group B, most of the grafted bones were degraded and absorbed at 4 weeks after operation, and osteoblasts were ossified at 8 weeks. The remaining implanted bones were still visible. Most of the osteoblasts were ossified and became lamellar bones at 12 weeks. In the group C, the defect area was filled with a large amount of fibrous connective tissues at 12 weeks after operation, and there was no bone formation. To conclude, the prefabricated composite tissue flap can be used to repair the bone and soft tissue defects of the extremities, and it has a faster and better therapeutic effect than the traditional free bone repair.

Key words: prefabricated composite tissue flap, transplantation, extremities, soft tissue injury

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