Emergency Soft Tissue Reconstruction Algorithm in Patients With Open Tibia Fractures

Иванов, П. А.; Shibaev, E.U.; Nevedrov, A. V.; Власов, А. П.; Lasarev, M.P.

doi:10.2174/1874325001610010364

Cited by 10 publications

(9 citation statements)

References 21 publications

(29 reference statements)

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“…However, the proportion of complications increased with age. Our finding is comparable with the findings of the study conducted by Ivanov et al [ 5 ], in which the majority of the cases were in the age range of 31–45 years (35%), followed by the age groups of 18–30, 46–60, and > 60 years, which accounted for 34%, 20%, and 7% of cases, respectively. However, a systematic review by de Blacam et al [ 2 ] correlated sural flap complications with predisposing factors and reported that age and venous insufficiency were independent risk factors for flap and wound complications.…”

Section: Discussionsupporting

confidence: 92%

“…No statistically significant correlation was found between sex and complications. In the study by Ivanov et al [5], 15 cases (17.6%) were female and 70 (82.4%) cases were male, which is a comparable ratio to that of our study. In the study conducted by Chua et al [9], 6.74% of the patients were female patients and 93.36% were male.…”

Section: Sex and Flap Complicationssupporting

confidence: 89%

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Evaluation of pedicled flaps for type IIIB open fractures of the tibia at a tertiary care center

et al. 2021

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Background Soft tissue coverage plays a vital role in replacing the vascularity of the underlying bone in Gustilo type IIIB fractures. The aim of this article was to evaluate the feasibility of local pedicled flaps in type IIIB fractures at a tertiary care center.Methods We included all cases of open Gustilo-Anderson type IIIB fractures of the tibia treated with local flap coverage from January 2017 to February 2019. We carried out a retrospective analysis to investigate the relationships of complications, hospital stay, and cost-effectiveness with the choice of flap, infective foci, site and size of the defect, and type of fixation.Results Out of 138 Gustilo type IIIB fractures analyzed in our study, 27 cases had complications, of which 19 (13.76%) involved flap necrosis, four (2.89%) were infections, three (2.17%) involved partial necrosis, and one (0.72%) was related to bone spur development. Flap complications showed a statistically significant association with the perforator flap category (propeller flaps in particular) (P=0.001). Flap necrosis showed a significant positive correlation with cases treated within 3 weeks after trauma (P=0.046). A significant positive correlation was also found between defect size and the duration of hospital stay (P=0.03).Conclusions Although local flaps are harvested from the same leg that underwent trauma, their success rate is at least as high as microvascular flaps as reported from other centers. Amidst the local flaps, complications were predominantly associated with perforator flaps.

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Section: Discussionsupporting

confidence: 92%

Section: Sex and Flap Complicationssupporting

confidence: 89%

Evaluation of pedicled flaps for type IIIB open fractures of the tibia at a tertiary care center

et al. 2021

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“…Reconstructive algorithms for complex extremity injuries have been described with potential benefits in patient outcomes. 30 Based upon the above characterization of extremity DSTIs and the factors affecting their outcomes, we propose an extremity DSTI classification and management algorithm. Although we understand there are nuances to the management of DSTIs of different anatomic locations, the proposed classification system simplifies the injuries into 2 groups based upon the anatomic level of injured tissues, which is generalizable to various anatomic levels due to the presence of fascial structures in both the upper and lower extremity.…”

Section: Discussionmentioning

confidence: 99%

Degloving Soft Tissue Injuries of the Extremity: Characterization, Categorization, Outcomes, and Management

Velázquez

Whitaker

Pestana

2020

Plastic and Reconstructive Surgery - Global Open

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Background: We aimed to identify degloving soft tissue injury (DSTI) patient characteristics, injury and reconstruction patterns, and factors affecting outcomes of DSTI injuries to propose a reconstructive protocol for these injuries. Methods: A retrospective analysis of consecutive patients with DSTIs of an extremity over a 22-year period has been done. Results: 188 patients with 201 extremity DSTIs were included. Mean patient age was 37 years, with follow-up of 19.6 months. In total, 96% of injuries were related to motor vehicles or machinery, and 74.6% of DSTIs had injuries to structures deep to skin/subcutis. The avulsed tissue was utilized in reconstruction in 71.6% of cases and 86.8% of these experienced some loss of the used avulsed tissues. Of the total cases, 82% employed skin grafting in reconstruction. Dermal regeneration templates were used in 32% of patients. An estimated 86.5% of patients had negative pressure wound therapy utilized. Of the injured patients, 21% required flap reconstruction and 22% required some form of amputation. Age, body mass index, and tobacco use did not increase perioperative complications or amputation. DSTIs with injury to structures deep to skin/subcutis were associated with negative pressure wound therapy use ( P = 0.02). DSTIs with underlying fractures required more procedures to reach reconstruction completion ( P = 0.008), had more minor ( P = 0.49) and major perioperative complications ( P = 0.001), longer time to heal ( P = 0.002), and increased need for amputation ( P = 0.02). Conclusions: Factors affecting the reconstructive management and outcome of DSTIs include injury to structures deep to the skin/subcutis. We categorized DSTIs based on the level of injury and proposed a systematic approach to extremity DSTIs which may be utilized by plastic surgeons and other surgical services to manage these complex injuries.

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“…This reduced the time to union and the incidence of infection 35,36,37 . It should be emphasised that timing of early soft tissue reconstruction is still debatable with some studies advocating coverage within three to five days of injury 29,34,37,38,39 and others favouring immediate wound cover at the time of initial surgery 21,40 . Our five-year study supported the observation that if the patient were hemodynamically stable, delay in soft tissue cover was unnecessary, as it could lead to additional soft tissue loss and a further increase in chances of wound contamination.…”

Section: Discussionmentioning

confidence: 99%

Single-stage "Fix and Flap" gives Good Outcomes in Grade 3B/C Open Tibial Fractures: A Prospective Study

Singh¹,

Dhillon²,

Ss³

2020

Malays Orthop J

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Introduction:Grade 3B/C open tibial fractures with grossly contaminated degloving injuries have poor outcomes, with or without vascular injuries. Treatment decision oscillates between limb salvage and amputation. The standard protocol of repeated debridement and delayed wound cover is a challenge in developing countries due to overcrowded emergencies and limited operating room availability. We present results of our modified protocol involving primary stabilisation with external fixation and immediate wound cover as an aggressive modality of treatment. Material and Methods: Thirty-three patients with severe open tibial shaft fractures were managed using a standardised protocol of emergent debridement, external fixation and immediate wound cover with free distant/local rotational muscle flaps and fasciocutaneous flaps, and with vascular repair in Grade 3C fractures. Intra-articular fractures were excluded. Patients were followed for a minimum of three years, with an assessment of clinical, radiological and functional outcomes. Results: Wound cover was achieved with 24 distant free muscle flaps, four local rotational muscle flaps and five fasciocutaneous flaps. All fractures united with an average time to union of 40.3 weeks (16-88). Fifteen patients (45.4%) underwent only a single major surgery using primary definitive external fixation. Deep infection was seen in four patients (12.1%). Nineteen patients had excellent to good outcomes, six were fair, and eight were poor. Conclusion: "Fix and Flap" in the same sitting, using immediate wound cover and external fixation, has given good results in our hands despite the delayed presentation, the neurovascular deficit and the degloving injury. This may be a better management strategy in overcrowded tertiary care centres of developing countries, with a single surgical procedure in almost half the cases.

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Emergency Soft Tissue Reconstruction Algorithm in Patients With Open Tibia Fractures

Cited by 10 publications

References 21 publications

Evaluation of pedicled flaps for type IIIB open fractures of the tibia at a tertiary care center

Evaluation of pedicled flaps for type IIIB open fractures of the tibia at a tertiary care center

Degloving Soft Tissue Injuries of the Extremity: Characterization, Categorization, Outcomes, and Management

Single-stage "Fix and Flap" gives Good Outcomes in Grade 3B/C Open Tibial Fractures: A Prospective Study

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