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Stoneburner et al. Plast Aesthet Res 2020;7:13 Plastic and
DOI: 10.20517/2347-9264.2019.028 Aesthetic Research

Systematic Review Open Access

Review of soft tissue coverage options in distraction
osteogenesis of the extremity

Jacqueline Stoneburner , Beina Azadgoli , Anna C. Howell , Douglass Tucker , Geoffrey Marecek ,
2
1
2
1
1
Joseph Carey 1
1 Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA.
2 Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA.
Correspondence to: Dr. Joseph Carey, Division of Plastic and Reconstructive Surgery in the Department of Surgery, Keck School of
Medicine of USC, 1510 San Pablo St, Los Angeles, CA 90033, USA. E-mail: joseph.carey@med.usc.edu
How to cite this article: Stoneburner J, Azadgoli B, Howell AC, Tucker D, Marecek G, Carey J. Review of soft tissue coverage options in
distraction osteogenesis of the extremity. Plast Aesthet Res 2020;7:13. http://dx.doi.org/10.20517/2347-9264.2019.028
Received: 13 Sep 2019 First Decision: 15 Jan 2020 Revised: 12 Feb 2020 Accepted: 3 Mar 2020 Published: 20 Mar 2020

Science Editor: Matthew L. Iorio Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract

Aim: To review the choices of soft tissue coverage in distraction osteogenesis of the extremity.

Methods: A PubMed literature search yielded 14 articles included for systematic review. Data were extracted from each
article if available (sample size, patient age, surgical indications, type of flap, use of additional modalities, method of
bone osteogenesis, postoperative events, follow-up, satisfaction, weight-bearing status, and success rate). Unpaired
t-tests were performed to compare complication rates. A retrospective review of three cases was also conducted.

Results: Fourteen articles discussed 145 patients with a mean age of 33.4 years and 146 extremity injuries followed
over 3.3 years on average. Indications included chronic osteomyelitis or nonunion (58.2%) and acute trauma (41.8%).
Average time from injury was 1.1 years. Ilizarov frame was used in 12 articles. Free flaps (88.0%) or rotational flaps
(12.0%) were used, with muscle flaps (96.7%) being most common. Most extremities received free latissimus dorsi or
rectus abdominis flaps. Bone grafts and antibiotic beads were often used in conjunction. Although complications and
reoperations were not uncommon (up to 30%), 98.8% of patients on average were ultimately weight bearing and all
articles reported > 91% success rate. Additionally, the rates of any complication were not statistically different between
“fix and flap” protocol and flap or frame first. Lastly, a three-patient case series is presented.

Conclusion: Bone transport with soft tissue reconstruction remains an excellent choice for patients with large bony
defects or who are unable to undergo autologous bone grafting. Not one surgical approach to limb salvage is superior,
and decision should be made on a case by case basis between the surgeon and the patient.

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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