Experimental justification for the use of the artificial deformity creation method for the treatment of patients with extensive soft tissue defects

Abstract Objectives: Management of extensive soft tissue defects in open tibial fractures is challenging, particularly when flap-based reconstruction is contraindicated. Artificial deformity creation method combines controlled angulation, rotation, translation, and shortening to achieve primary soft tissue closure, followed by gradual deformity correction. This study experimentally evaluated the deformity parameters required for closure of transverse and longitudinal defects. Methods: Full-size tibial models with simulated soft tissue defects were mounted in circular external fixation with an orthopaedic hexapod. Defects were progressively enlarged, and the magnitudes of angulation, shortening, translation, and rotation needed for closure were measured. Regression analysis defined relationships between defect geometry and deformity components. Results: Transverse defects of soft tissues ≤20 mm were closed with angulation alone; larger defects required combined angulation and shortening to maintain safe angulation (<60°). Rotation had minimal value in transverse defects but was essential in closing longitudinal wounds, where angulation, rotation, and shortening interacted nonlinearly. Safe practical limits of artificial deformity for soft tissue defect closure were identified: angulation 60°, rotation 90°, shortening 80 to 90 mm. Conclusion: Artificial deformity creation represents a reliable alternative when flap reconstruction is not possible. These experimental data offer guidance for selecting deformity components based on defect size and orientation during limb-salvage procedures.