Masquelet combined with free-flap technique versus the Ilizarov bone transport technique for severe composite tibial and soft-tissue defects

Background The treatment of bone and soft-tissue defects after open fractures remains challenging. This study aimed to evaluate the clinical efficacy of the Masquelet technique combined with the free-flap technique (MFFT) and the Ilizarov bone transport technique (IBTT) for the treatment of severe composite tibial and soft-tissue defects. Methods We retrospectively analysed the data of 65 patients with tibial and soft-tissue defects and Gustilo type IIIB/C open fractures treated at our hospital between April 2015 and December 2021. The patients were divided into two groups based on the treatment method: group A (n=35) was treated with the MFFT and internal fixation, and group B (n=30) was treated with the IBTT. Results The mean follow-up period was 28 months (range 13–133 months). Complete union of both soft-tissue and bone defects was achieved in all cases. The mean bone-union times were 6 months (range 3–12 months) in group A and 11 months (range 6–23 month) in group B, with a significant difference between the two groups (Z=–4.11, P=0.001). The mean hospital stay was 28 days (range 14–67 d) in group A which was significantly longer than the mean stay of 18 days (range 10–43 d) in group B (Z=–2.608, P=0.009). There were no significant differences in the infection rate between group A (17.1%) and group B (26.7%) (χ2=0.867, P=0.352). The Total Physical Health Scores were 81.51±6.86 (range 67–90) in group A and 75.83±16.14 (range 44–98) in group B, with no significant difference between the two groups (t=1.894, P=0.063). The Total Mental Health Scores were significantly higher in group A (90.49±6.37; range 78–98) than in group B (84.70±13.72; range 60–98) (t=2.232, P=0.029). Conclusion Compared with IBTT, MFFT is a better choice of treatment for open tibial and soft-tissue defects with Gustilo IIIB/C fractures. IBTT is the preferred option when the tibial bone defect is large or if the surgeon's expertise in microsurgery is limited.