Establishment and clinical application of limb compound tissue defect classification

XIANG Dongquan; ZHAO Jianwen; ZHAO Xuelin; LI Jianxiong; LIAO Song; GUO Zixuan; ZHAO Ziyi; ZHANG Jianzheng; XU Meng

doi:10.3969/j.issn.2095-5227.2022.08.001

Volume 43 Issue 8

Sep. 2022

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ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL > 2022 > 43(8): 817-822, 829. > DOI: 10.3969/j.issn.2095-5227.2022.08.001

XIANG Dongquan, ZHAO Jianwen, ZHAO Xuelin, LI Jianxiong, LIAO Song, GUO Zixuan, ZHAO Ziyi, ZHANG Jianzheng, XU Meng. Establishment and clinical application of limb compound tissue defect classification[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2022, 43(8): 817-822, 829. DOI: 10.3969/j.issn.2095-5227.2022.08.001

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Establishment and clinical application of limb compound tissue defect classification

XIANG Dongquan^{1, 2,},
ZHAO Jianwen¹,
ZHAO Xuelin^{1, 2},
LI Jianxiong^{1, 2},
LIAO Song^{1, 2},
GUO Zixuan^{1, 2},
ZHAO Ziyi^{1, 2},
ZHANG Jianzheng¹,
XU Meng^1, ,

1.
Department of Orthopeadics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing 100039, China
2.
Graduate School of Chinese PLA General Hospital, Beijing 100853, China

Funds: Supported by the National Natural Science Foundation of China (81972901); the National Defense Science and Technology Foundation Enhancement Plan (2019-JCJQ-JJ-147); the Key Basic Research Projects of the National Defense Science and Technology Foundation Enhancement Plan (2019-JCJQ-ZD-120-40)

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Corresponding author:
XU Meng. Email: 13501175839@163.com.
Received Date: May 26, 2022
Available Online: June 28, 2022

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Abstract

Abstract

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.
- compound tissue defect,
- bone tumor,
- limb compound tissue defect classification,
- preoperative evaluation,
- reconstruction

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