Closure of the skin defect overlying infected non-union 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 one case of infected knee arthrodesis. Five patients presented with infected non-union of the tibia (all 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 sinus and infected skin, excision of the infected non-union, stabilisation of bone with an Ilizarov circular frame and either acute shortening with compression followed by distraction (3 patients), or bone transport (2 patients). After excision of the sinus, the skin defect was gradually closed using a skin traction device placed on an Ilizarov circular frame. The size of the wounds ranged from 5 x 14 cm to 3 x 5 cm and skin traction was completed at 4 weeks (range 2-8 weeks). When the wound edges were approximated, the wires were left in place until healthy granulation tissue built up to seal the remaining gap (sutures were 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 infection 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, red or pink in colour, hypersensitive in 2 patients and numb in 3 patients.