When is the Critical Time for Soft Tissue Reconstruction of Open Tibia Fracture Patients?

Complication Rates ◽

Abstract Background The timing of soft tissue reconstruction for soft-tissue defect in patients with open fractures in the lower extremity is known to be critical for successful outcomes. However, medical advances, including development of dressing materials and refinement in the microsurgical techniques, might have undergone modifications in this “critical period.” There have been no studies on the role of timing on reconstructive outcomes. Thus, we have analyzed the effect of reconstruction timing on optimal surgical outcomes and complication rates in a single type of lower extremity injury. Methods Data of patients who underwent microvascular free tissue transfer with an open fracture in the lower extremity from 2014 through 2016 were retrospectively reviewed (n = 103). Surgical outcomes, including flap complication rate, flap revision rate, and long-term bony complications, were analyzed serially in accordance with time interval until coverage using the receiver operating characteristic (ROC) curve analysis. Significant factors with a p < 0.05 in the univariate analysis were included in the multivariate logistic regression model to identify independent risk factors. Results A total of 46 patients (33 males and 13 females) were finally included in the study. Based on the association between surgical timing and flap-related complication rate, the best cutoff period for surgery was 33 days, with an area under the curve of 0.658 (p = 0.040). Further, in the revision rate, the cutoff period was identified as 10 days (p = 0.016). Regarding the incidence of bony complications, ROC curve showed that the maximal period until operation was 91 days with no influence on the occurrence of bony complications (p = 0.029). Conclusion Although the best method is an early reconstruction, many modalities such as negative pressure wound therapy play a role as a temporary measure. Our study suggests that the acute or early period for successful reconstruction might be extended compared with previous studies.

Outcomes of Soft Tissue Reconstruction for Traumatic Lower Extremity Fractures with Compromised Vascularity

The American Surgeon ◽

10.1177/000313481708301030 ◽

2017 ◽

Vol 83 (10) ◽

pp. 1161-1165 ◽

Cited By ~ 3

Author(s):

Ido Badash ◽

Karen E. Burtt ◽

Hyuma A. Leland ◽

Daniel J. Gould ◽

Alexis D. Rounds ◽

...

Keyword(s):

Soft Tissue ◽

Lower Extremity ◽

Limb Salvage ◽

Arterial Injury ◽

Complication Rates ◽

Arterial Injuries ◽

Flap Failure ◽

Vascular Compromise ◽

Traumatic lower extremity fractures with compromised arterial flow are limb-threatening injuries. A retrospective review of 158 lower extremities with traumatic fractures, including 26 extremities with arterial injuries, was performed to determine the effects of vascular compromise on flap survival, successful limb salvage and complication rates. Patients with arterial injuries had a larger average flap surface area (255.1 vs 144.6 cm2, P = 0.02) and a greater number of operations (4.7 vs 3.8, P = 0.01) than patients without vascular compromise. Patients presenting with vascular injury were also more likely to require fasciotomy [odds ratio (OR): 6.5, confidence interval (CI): 2.3–18.2] and to have a nerve deficit (OR: 16.6, CI: 3.9–70.0), fracture of the distal third of the leg (OR: 2.9, CI: 1.15–7.1) and intracranial hemorrhage (OR: 3.84, CI: 1.1–12.9). After soft tissue reconstruction, patients with arterial injuries had a higher rate of amputation (OR: 8.5, CI: 1.3–53.6) and flap failure requiring a return to the operating room (OR: 4.5, CI: 1.5–13.2). Arterial injury did not correlate with infection or overall complication rate. In conclusion, arterial injuries resulted in significant complications for patients with lower extremity fractures requiring flap coverage, although limb salvage was still effective in most cases.

Soft tissue reconstruction and salvage of infected fixation hardware in lower extremity trauma

Microsurgery ◽

10.1002/micr.30176 ◽

2017 ◽

Vol 38 (3) ◽

pp. 259-263 ◽

Cited By ~ 1

Author(s):

Hyuma A. Leland ◽

Alexis D. Rounds ◽

Karen E. Burtt ◽

Daniel J. Gould ◽

Geoffrey S. Marecek ◽

...

Keyword(s):

Soft Tissue ◽

Lower Extremity ◽

Lower Extremity Trauma ◽

Extremity Trauma ◽

A review of propeller flaps for distal lower extremity soft tissue reconstruction: Is flap loss too high?

Microsurgery ◽

10.1002/micr.22134 ◽

2013 ◽

Vol 33 (7) ◽

pp. 578-586 ◽

Cited By ~ 44

Author(s):

Jonas A. Nelson ◽

John P. Fischer ◽

Philip S. Brazio ◽

Stephen J. Kovach ◽

Gedge D. Rosson ◽

...

Keyword(s):

Soft Tissue ◽

Lower Extremity ◽

Flap Loss ◽

Does Laterality of Lower Extremity Donor Site Affect Outcomes in Microvascular Soft Tissue Lower Extremity Reconstruction?

Journal of Reconstructive Microsurgery ◽

10.1055/s-0039-1701037 ◽

2020 ◽

Vol 36 (04) ◽

pp. 289-293

Author(s):

Jason W. Yu ◽

William J. Rifkin ◽

Z-Hye Lee ◽

Zachary Borab ◽

Allyson R. Alfonso ◽

...

Keyword(s):

Soft Tissue ◽

Lower Extremity ◽

Donor Site ◽

Contralateral Side ◽

Complication Rates ◽

Flap Survival ◽

Flap Failure ◽

Vascular Compromise ◽

Lower Extremity Reconstruction

Abstract Background There are many different variables to consider in lower extremity microvascular soft tissue reconstruction including flap choice. Our aim is to objectively evaluate recipient complications related to lower extremity donor flap laterality. Methods A total of 77 lower extremity soft tissue reconstructions utilizing microvascular free tissue transfers for Gustilo type III between 1979 and 2016 were collected. We compared complication rates between ipsilateral and contralateral donor sites relative to the injured leg. The following parameters were analyzed: overall complications, total flap failure, partial flap failure, major complications, operative takebacks, and salvage rates. Results In this study, 25 ipsilateral reconstructions were performed, while 52 cases utilized the contralateral leg. Overall complication rates were higher in the ipsilateral group (40.0%) compared with the contralateral side (23.1%) but were not statistically significant (p = 0.12). The ipsilateral group was four times as likely to experience vascular compromise (24.0 vs. 5.8%; p = 0.05). However, there were no significant differences in complications, flap failures or flap survival. Mean operative time was significantly greater in the same side group as compared with the contralateral group (11.3 vs. 7.5 hours; p = 0.006). Conclusion Although there is a higher risk of anastomotic thrombosis, particularly venous thrombosis, associated with ipsilateral donor-site group, there were no significant differences in complications or flap survival. Flaps can be harvested from a traumatized leg with acceptable complication rates while avoiding the morbidity of operating on an uninjured limb.