Masquelet combined with free-flap technique versus the Ilizarov bone transport technique for severe composite tibial and soft-tissue defects.

• Gustilo grades IIIB/C open tibial fractures are severe and require aggressive, multidisciplinary management. • Large tibial defects combined with large soft tissue defects are challenging problems in clinical practice. • This study compared the effects of MFFT and IBTT by retrospectively analysing clinical data. • For open tibial and soft tissue defects in Gustilo IIIB/C fractures, MFFT should be the first treatment choice if the surgeon has a high level of microsurgical skills. • MFFT achieves faster healing, less discomfort, and may be better appearance within the bone and soft tissue defect. The treatment of bone and soft-tissue defects after open fractures remains challenging. This study aimed to evaluate the clinical efficacy of the Masquelet technique combined with the free-flap technique (MFFT) versus the Ilizarov bone transport technique (IBTT) for the treatment of severe composite tibial and soft-tissue defects. We retrospectively analysed the data of 65 patients with tibial and soft-tissue defects and Gustilo type IIIB/C open fractures treated at our hospital between April 2015 and December 2021. The patients were divided into two groups based on the treatment method: group A (n = 35) was treated with the MFFT and internal fixation, and group B (n = 30) was treated with the IBTT. The mean follow-up period was 28 months (range 13–133 months). Complete union of both soft-tissue and bone defects was achieved in all cases. The mean bone-union times were 6 months (range 3–12 months) in group A and 11 months (range 6–23 month) in group B, with a significant difference between the two groups (Z = –4.11, P = 0.001). The mean hospital stay was 28 days (range 14–67 d) in group A which was significantly longer than the mean stay of 18 days (range 10–43 d) in group B (Z = –2.608, P = 0.009). There were no significant differences in the infection rate between group A (17.1 %) and group B (26.7%) (χ2 = 0.867, P = 0.352). The Total Physical Health Scores were 81.51 ± 6.86 (range 67–90) in group A and 75.83±16.14 (range 44–98) in group B, with no significant difference between the two groups (t = 1.894, P = 0.063). The Total Mental Health Scores were significantly higher in group A (90.49 ± 6.37; range 78–98) than in group B (84.70 ± 13.72; range 60–98) (t = 2.232, P = 0.029). Compared with IBTT, MFFT is a better choice of treatment for open tibial and soft-tissue defects with Gustilo IIIB/C fractures. IBTT is the preferred option when the tibial bone defect is large or if the surgeon's expertise in microsurgery is limited. [ABSTRACT FROM AUTHOR]