Acute Shortening: Modular Treatment Modality for Severe Combined Bone and Soft Tissue Loss of the Extremities

Abstract

Acute shortening, using the Ilizarov technique followed by progressive lengthening, is one of the methods used to deal with complex fractures combined with severe soft tissue injuries. We have summarized 12 patients who underwent acute shortening and stabilization using the Ilizarov frame. Nine of them underwent progressive lengthening to restore the length. For three patients, angulation of the bone segments was performed to save them from excessive bone debridement. Total wound closure and bone regeneration were achieved in all our patients. Five patients had pin-tract infection without involvement of the bone, and no major complications were noted. Using this technique, we found some advantages. First, there is less need for free and local flaps. Second, there is a decrease in the operating time and donor-site morbidity (important for patients with multiple organ trauma). Third, it provides a good option for restoring defects in severe cases with combined bone and soft tissue defects in the same session. Fourth, its implementation for short bone defects (< 3 cm) gives acceptable aesthetic and functional results. Fifth, angulation of the segments and subsequent graduated correction of misalignment reduces the length of shortening needed in patients with severe soft tissue loss by sparing the bone from unnecessary debridement. Sixth, it permits definitive treatment using an external fixator device, enabling the possibility of early functional loading. On the basis of our experience, we suggest adopting this method for functional limb salvage after extensive complex high-energy injuries.