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

Abstract

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. 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. 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. 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.