Application of a pre-filled tissue expander for preventing soft tissue incarceration during tibial distraction osteogenesis

Figure 1 The length of the necrotic tibia was approximately 9 cm and the necrotic tissue was completely removed by debridement. A: The length of tibial necrosis was approximately 9 cm in this patient with an open tibiofibular fracture caused by a traffic accident; B: The necrotic tibia was removed by complete debridement.

Figure 2 Antibiotic-polymethyl methacrylate beads were implanted intraoperatively after complete debridement.

Figure 3 Three months later, the antibiotic-polymethyl methacrylate beads were removed from the lacuna, the expander was inserted and filled. A: Antibiotic-polymethyl methacrylate beads were removed from the right leg; B: The expander was inserted and filled after the antibiotic-polymethyl methacrylate beads were removed; C: On the X-ray, the valve of the expander was intact and safely in position.

Figure 4 Distraction osteogenesis was initiated. After 126 d, the distance between the two bone ends was less than 1 cm.

Figure 5 During the entire treatment period, tissue incarceration did not occur.

Figure 6 Expander removal and fibular osteotomy were carried out.

Figure 7 Good incision healing was achieved postoperatively.