CLOSURE OF THE SKIN DEFECT OVERLYING INFECTED NONUNION BY SKIN TRACTION

Skin traction based on an Ilizarov frame has been used to achieve skin closure in five cases of infected non-union of the tibia including on e case of infected knee arthrodesis. Five patients presented with infe cted non-union of the tibia tall Staph. aureus, two of them MRSA) with overlying sinuses discharging pus at an average 16 months from injury (range 3-36 months). The infections were treated by excision of the s inus and infected skin, excision of the infected non-union, stabilisat ion of bone with an Ilizarov circular frame and either acute shortenin g with compression followed by distraction (3 patients), or bone trans port (2 patients). After excision of the sinus, the skin defect was gr adually closed using a skin traction device placed on an Ilizarov circ ular frame. The size of the wounds ranged from 5 x 14 cm to 3 x 5 cm a nd skin traction was completed at 4 weeks (range 2-8 weeks). When the wound edges were approximated, the wires were left in place until heal thy granulation tissue built up to seal the remaining gap (sutures wer e used in two patients). At follow-up assessment at 18 months (range 7 -24 months), all non-union were solidly united with no signs of infect ion of either the bone or underlying skin. The quality of skin at the stretching site was found to be of normal sensation, colour, mobility but thinner than normal. The quality of the skin at the docking site ( left to granulate) was found to be adherent to the underlying bone, re d or pink in colour, hypersensitive in 2 patients and numb in 3 patien ts.