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. 2018 Aug;13(2):103-108.
doi: 10.1007/s11751-018-0304-3. Epub 2018 Jan 24.

The tibial bayonet method of wound closure

Peter O'Farrell  1 , Annette-Christi Barnard  2 , Franz Birkholtz  2   3
Affiliations

The tibial bayonet method of wound closure

Peter O'Farrell et al. Strategies Trauma Limb Reconstr. 2018 Aug.

Abstract

Management of open lower limb fractures with soft tissue defects can be a technically challenging orthopaedic problem. Limited availability of orthoplastic services means that alternatives to the fix and flap concept are required in order to prevent infected non-unions from developing. The proposed 'bayonet apposition' allows the surgeon to temporarily shorten the limb without angulating the limb or creating a bone defect and removing viable bone. The viable bone edges are overlapped in a bayonet-like manner in order to appose the wound and skin edges. The limb length is restored by gradually distracting the bone segments once the soft tissues have healed. This is facilitated with a hexapod fixator for stabilization of the fracture and distraction. Prerequisites for utilizing this method are circumferential soft tissue damage to the lower limb with viable distal tissue. The bayonet method allows primary closure of a wound and rapid restoration of the native length of the limb.

Keywords: Bayonet method; Compound tibial fractures; Duplication; Hexapod-assisted closure; Limb salvage.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The content of the article is the sole work of the authors. One or more of the authors are paid educational consultants for the medical device companies mentioned in the text. The procedures followed were in accordance with the ethical standards of the Helsinki Declaration (1964, amended most recently in 2008) of the World Medical Association. The patient’s written consent was obtained for inclusion of his data in this paper.

Figures

Fig. 1
Fig. 1
Line drawing of bayonet apposition to demonstrate the overriding of the bone segments, indicating the AP view (a) and lateral view (b)
Fig. 2
Fig. 2
Extent of soft tissue injury following debridement awaiting definitive fixation
Fig. 3
Fig. 3
Two orthogonal views following the bayonet technique (post-operatively) lateral (a) and AP (b)
Fig. 4
Fig. 4
Soft tissue closure facilitated by bayonetting the tibia
Fig. 5
Fig. 5
Bone segment alignment following distraction and realignment, lateral (a) and AP (b)
Fig. 6
Fig. 6
A final photograph of the healed limb, indicating that the soft tissue showed no signs of infection and the durability was good
Fig. 7
Fig. 7
Radiograph series of 2-year follow-up. Fracture united and bone is aligned
See this image and copyright information in PMC

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