Background Compound tissue defect (CTD), caused by high-energy trauma or tumor invasion, is one of the most difficult conditions in clinical practice, and there is no unified evaluation standard for the classification and severity of CTD.
Objective To propose a new classification method for the normalized reconstruction of compound tissue.
Methods According to previous research and clinical experience, our team established a limb compound tissue defect classification (LCTDC) system based on the type and degree of soft tissue defect (S), bone defect (B) and nerve defect (N). The compound tissue defects were divided into 3 categories (LCTDC Ⅰ, Ⅱ, Ⅲ) and 8 subtypes (ⅠA,ⅠB,ⅠC, ⅡA, ⅡB, ⅡC, ⅢA, ⅢB). Totally 175 patients with limb tumor or CTD caused by high-energy injury who underwent multi-compartment resection in the Department of Orthopedics of our hospital from June 2019 to December 2021 were included. According to the preoperative examinations and imaging data, two groups of orthopedists (including 6 attending orthopedists in group A and 2 chief orthopedists in group B) performed assessment to tissue defects based on LCTDC system, and made surgical plans. Kappa consistency test was performed on the evaluation results of doctors in group A using the results of group B as the gold standard.
Results Of the 175 CTD patients, there were 113 males and 62 females, with an average age of 28.3 years. There were 113 cases with large bone and soft tissue tumors in limbs, and 62 cases with complex tissue defects after high energy trauma of limbs.The LCTDC types assessed by two chief orthopedists in group B were as follows: 40 cases of typeⅠ, 79 cases of typeⅡ, 56 cases of type Ⅲ, The Kappa coefficient of consistency assessment on the general LCTDC classification was 0.783 (P＜0.05), and the Kappa coefficient on the subtypes (including the development of surgical plan) ranged from 0.671 to 0.821 (all P＜0.05).
Conclusion There is a high consistency in the results of CTD classification and subtype determination between the experienced and young orthopedists. The LCTDC established in this study can guide orthopedists to perform preoperative injury assessment and select a reasonable reconstruction method for patients, which is beneficial to standardize and optimize the surgical strategy and improve the success rate of surgery.
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