Simultaneous debridement, soft tissue coverage and application of Ilizarov ring external fixator in the management of open complex limb injuries

M. Hamidul Islam; Muhammad Anwar Hossen; Akman Hossain; K. M. Shorfuddin; M. Sazzad Hossain; Asif Rahman; M. Nasir Uddin; S. M. Faisal Haque

doi:10.18203/issn.2455-4510.IntJResOrthop20263894

Authors

M. Hamidul Islam Department of Orthopedic Surgery, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh
Muhammad Anwar Hossen Department of Orthopedic Surgery, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh
Akman Hossain Department of Orthopedic Surgery, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh
K. M. Shorfuddin Department of Orthopedic Surgery, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh
M. Sazzad Hossain Department of Orthopedic Surgery, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh
Asif Rahman Department of Orthopedic Surgery, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh
M. Nasir Uddin Department of Orthopedic Surgery, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh
S. M. Faisal Haque Department of Orthopedic Surgery, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20263894

Keywords:

External fixation, Ilizarov technique, Limb salvage, Open complex limb injuries, Soft tissue coverage

Abstract

Background: Open complex limb injuries with significant bone and soft tissue defects present substantial reconstructive challenges. Traditional staged management prolongs recovery and increases complication risks. This study evaluated the outcomes of simultaneous debridement, soft tissue coverage, and Ilizarov ring external fixation in managing such injuries.

Methods: This quasi-experimental study was conducted at NITOR, Dhaka, from March 2023 to September 2025. Thirty-five patients with open complex limb injuries underwent single-stage debridement, Ilizarov fixation, and soft tissue coverage. Outcomes assessed included radiological union, complications, and bone and functional results using ASAMI criteria.

Results: The mean age was 35.2±10.35 years, with males predominating (89%). Motor vehicle accidents were the leading cause (86%). Radiological union was achieved in 94.3% (n=33) at a mean of 6.61±0.93 months. Complications occurred in 11.4% (n=4), with pin tract infection being most common (8.6%). According to ASAMI criteria, excellent bone outcomes were seen in 60% and functional outcomes in 60%. Complete flap survival was observed in 62.9% (n=22), with no total flap failures. The mean soft tissue defect size was 76.74 ± 34.54 cm².

Conclusions: Simultaneous debridement, soft tissue coverage, and Ilizarov reconstruction is a safe and effective strategy for open complex limb injuries, achieving high union rates, acceptable complications, and favorable functional outcomes.

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