A Comparative Study of Doppler‐Guided Acute Bone Shortening‐Lengthening Versus Bone Transport for Infected Tibial Defects Combined With Soft Tissue Defects

OBJECTIVE: The management of infected tibial bone defects with soft tissue defects (ITBD-STD) remains challenging. This study aims to establish a Doppler-guided safety threshold for acute shortening (≤ 3 cm), compare the clinical efficacy and safety of shortening-lengthening (S-L) versus bone transport (BT), quantify the complication burden, and clarify the calculation indices. METHODS: test. RESULTS: The WHT in the S-L group was significantly shorter than that in the BT group (68.5 ± 25.2 vs. 85.2 ± 21.5 days, p < 0.05). In the S-L group, acute shortening was successfully performed in all 22 patients under real-time Doppler guidance, with a mean acute shortening distance of 2.8 ± 0.4 cm (capped at 3 cm). No patient experienced Doppler signal loss or required intraoperative termination of shortening due to vascular compromise. The BHI (37.36 ± 10.73 vs. 44.14 ± 11.12 days/cm) and EFI (45.36 ± 11.23 vs. 53.52 ± 12.55 days/cm) in the S-L group were significantly lower than those in the BT group (all p < 0.05). However, there was no statistically significant difference in the overall complication rate between the two groups (45.5% vs. 42.9%, p > 0.05). At the final follow-up, there was also no statistically significant difference in ASAMI scores between the two groups (p > 0.05). CONCLUSION: Both S-L and BT are effective for ITBD-STD with comparable safety. Under the strict Doppler-guided protocol (≤ 3 cm), S-L significantly shortens WHT without increasing complications, yet this benefit is design-inherent rather than a biological advantage. Given comparable ASAMI functional outcomes, S-L offers no functional superiority over BT. Nonetheless, the Doppler criteria and selection strategy established herein provide a safe, reproducible framework for technique selection, validating the clinical feasibility of acute shortening without compromising final function or safety.