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Introduction <p>Chronic non-healing wounds, defined as wounds persisting for more than six weeks without demonstrable healing despite appropriate standard care, often complicate open tibial fractures due to soft-tissue loss, infection, and vascular compromise. Although initially designed for bone reconstruction, the Ilizarov technique also promotes soft-tissue repair via histogenesis and neoangiogenesis through the principle of distraction histogenesis.</p> Materials and Methods <p>This prospective observational study (August 2016–January 2020) included 87 patients (4–76&#xa0;years) with complex lower-limb wounds associated with fractures, non-unions, or osteomyelitis, treated with the Ilizarov external fixator (IEF). Exclusion criteria were venous ulcers, nerve injuries, and dermatological wounds. Wounds were evaluated using the Bates–Jensen criteria by a single assessor to minimize bias. Data collected included demographics, comorbidities (including alcohol and smoking status), infection status, and adjunctive interventions, such as corticotomy, vacuum-assisted closure (VAC), and skin grafting.</p> Results <p>Complete healing occurred in 83.91% of patients. Corticotomy was performed in 67.82% of cases. No significant association was observed between healing and age, sex, comorbidities, or duration of fixator use; however, this study was underpowered to assess the independent impact of comorbidities. All four pediatric patients (&lt; 10&#xa0;years) healed completely. VAC therapy and skin grafting improved wound closure rates. Complications occurred in 11.49% of patients, including isolated cases of gangrene, infection recurrence, and one amputation, but no implant failures were reported.</p> Conclusion <p>The Ilizarov method, particularly when combined with corticotomy, is effective for managing chronic lower-limb wounds. Adjunctive VAC therapy and skin grafting further enhance outcomes. The Bates–Jensen score is a reliable predictor of healing progression. This approach is effective across diverse age groups, including young children (<i>n</i> = 4), all of whom achieved complete healing.</p>

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The Role of Ilizarov Technique in Chronic Non-healing Wounds of the Lower Limb: A Prospective Observational Study

  • 期刊论文

  • 发表日期：

    2025年12月6日

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  • L. Haricharan,
  • N. Harshith,
  • Harshad Mohan Shah,
  • Prabhat Mittal

摘要

Introduction

Chronic non-healing wounds, defined as wounds persisting for more than six weeks without demonstrable healing despite appropriate standard care, often complicate open tibial fractures due to soft-tissue loss, infection, and vascular compromise. Although initially designed for bone reconstruction, the Ilizarov technique also promotes soft-tissue repair via histogenesis and neoangiogenesis through the principle of distraction histogenesis.

Materials and Methods

This prospective observational study (August 2016–January 2020) included 87 patients (4–76 years) with complex lower-limb wounds associated with fractures, non-unions, or osteomyelitis, treated with the Ilizarov external fixator (IEF). Exclusion criteria were venous ulcers, nerve injuries, and dermatological wounds. Wounds were evaluated using the Bates–Jensen criteria by a single assessor to minimize bias. Data collected included demographics, comorbidities (including alcohol and smoking status), infection status, and adjunctive interventions, such as corticotomy, vacuum-assisted closure (VAC), and skin grafting.

Results

Complete healing occurred in 83.91% of patients. Corticotomy was performed in 67.82% of cases. No significant association was observed between healing and age, sex, comorbidities, or duration of fixator use; however, this study was underpowered to assess the independent impact of comorbidities. All four pediatric patients (< 10 years) healed completely. VAC therapy and skin grafting improved wound closure rates. Complications occurred in 11.49% of patients, including isolated cases of gangrene, infection recurrence, and one amputation, but no implant failures were reported.

Conclusion

The Ilizarov method, particularly when combined with corticotomy, is effective for managing chronic lower-limb wounds. Adjunctive VAC therapy and skin grafting further enhance outcomes. The Bates–Jensen score is a reliable predictor of healing progression. This approach is effective across diverse age groups, including young children (n = 4), all of whom achieved complete healing.