Synchronus Circular Frame Stabilisation and Microsurgical Soft Tissue Reconstruction for the Acute Management of Open Lower Limb Fractures

Soft tissue coverage of open fractures with well-vascularised tissues should be performed within 72 hours of injury or at the same time as internal fixation. It may be in the form of local or free flaps, and may comprise muscle, fasciocutaneous tissues, or both. Flap selection depends on multiple factors, including the size and location of the defect following wound excision, availability of flaps, and donor site morbidity. Local flaps are usually used to cover defects with a limited zone of injury. Anastomoses for free flaps should be performed outside the zone of injury. Experimental data suggest that coverage with muscle leads to improved healing of fractures. However, there is currently little clinical evidence to support the use of one form of soft tissue cover over another for open fractures of the lower limb. The plastic surgeon must always consider the donor site morbidity of the flap(s) chosen.

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Functional Reconstruction of Sarcoma Defects Utilising Innervated Free Flaps

Sarcoma ◽

10.1155/2012/315190 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 21

Author(s):

Damien Grinsell ◽

Claudia Di Bella ◽

Peter F. M. Choong

Keyword(s):

Soft Tissue ◽

Abdominal Wall ◽

Upper Limb ◽

Lower Limb ◽

Free Flaps ◽

Functional Results ◽

Wide Resection ◽

Soft Tissue Reconstruction ◽

Functional Scores ◽

Tissue Reconstruction

Soft-tissue reconstruction following preoperative radiotherapy and wide resection of soft tissue sarcoma remains a challenge. Pedicled and free tissue transfers are an essential part of limb sparing surgery. We report 22 cases of sarcoma treated with radiotherapy and wide excision followed by one-stage innervated free or pedicled musculocutaneous flap transfers. The resection involved the upper limb in 3 cases, the lower limb in 17, and the abdominal wall in 2. The flaps used for the reconstruction were mainly latissimus dorsi and gracilis. The range of motion was restored fully in 14 patients. The muscle strength of the compartment reconstructed was of grades 4 and 5 in all patients except one. The overall function was excellent in all the cases with functional scores of 71.2% in the upper limb and 84% in the lower limb. The only 2 major complications were flap necrosis, both revised with another flap, one of which was innervated with restoration of function. Innervated flaps are valuable alternatives for reconstruction after sarcoma resection in the extremity and in the abdominal wall. The excellent functional results are encouraging, and we believe that innervated muscle reconstruction should be encouraged in the treatment of sarcoma after radiotherapy and wide resection.

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University of the Witwatersrand physiotherapy undergraduate curriculum alignment to medical conditions of patients within Gauteng state health facilities

South African Journal of Physiotherapy ◽

10.4102/sajp.v73i1.362 ◽

2017 ◽

Vol 73 (1) ◽

Author(s):

Mokgobadibe V. Ntsiea ◽

Witness Mudzi ◽

Nicolette Comley-White ◽

Heleen Van Aswegen ◽

Benita Olivier ◽

...

Keyword(s):

Soft Tissue ◽

Lower Limb ◽

Soft Tissue Injuries ◽

Health Facilities ◽

Medical Conditions ◽

State Health ◽

Icu Patients ◽

Lower Limb Fractures ◽

Tissue Injuries ◽

Limb Fractures

Background: The healthcare sector requires graduates with the ability to confidently assess and manage the majority of the medical conditions seen in hospitals.Objective: To establish whether the most prevalent medical conditions treated by physiotherapists in Gauteng (South Africa) state health facilities align with the University of the Witwatersrand (Wits) physiotherapy curriculum.Methods: This was a retrospective review of condition-related statistics from physiotherapy departments within the Gauteng province state health facilities. Data from all Gauteng government hospitals that had submitted at least 75% of their physiotherapy condition–related statistics to the provincial statistics coordinator from January 2012 to December 2014 were considered and compared to medical conditions covered in the Wits 2015 physiotherapy curriculum to check if all conditions listed in the Gauteng statistics appeared within the Wits curriculum document. The number of teaching hours for the common conditions was noted to check the emphasis given to these conditions in the curriculum.Results: Eighty-three per cent of the hospitals submitted 75% of their monthly statistics. Overall, the most common conditions treated were lower limb fractures (13%) followed by stroke (7.6%) (n = 705 597). Within the neuro-musculoskeletal category, the most common conditions after lower limb fractures were soft tissue injuries (15.1%) (n = 330 511). The most common cardiopulmonary conditions were tuberculosis (24.9%), followed by pneumonia (13.8%) (n = 94 895). The most common neurological conditions were stroke (30.9%) followed by cerebral palsy (17%) (n = 174 024). Within the non-specified categories, the number of intensive care unit (ICU) patients was the highest (23%), followed by sputum induction (21%) (n = 138 187). The most common conditions that were emphasised within the Wits curriculum as indicated by the teaching hours: fractures, 14.5 (66%) of 22 third-year orthopaedics hours; stroke, 30 (73%) of 41 third-year neurology hours; soft tissue injuries, 18 (38%) of 48 fourth-year neuro-musculoskeletal hours; back lesions, 24 (50%) of 48 fourth-year neuro-musculoskeletal hours; and ICU patients, 30 (79%) of 38 fourth-year cardiopulmonary hours.Conclusion: The Wits physiotherapy curriculum covers all medical conditions treated by physiotherapists within the Gauteng state health facilities, and overall, the curriculum prepares the students to practise in a variety of situations.

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Soft-Tissue Reconstruction of Open Fractures of the Lower Limb

Plastic & Reconstructive Surgery ◽

10.1097/prs.0b013e3182589e63 ◽

2012 ◽

Vol 130 (2) ◽

pp. 284e-295e ◽

Cited By ~ 69

Author(s):

James K.-K. Chan ◽

Lorraine Harry ◽

Garry Williams ◽

Jagdeep Nanchahal

Keyword(s):

Soft Tissue ◽

Lower Limb ◽

Open Fractures ◽

Soft Tissue Reconstruction ◽

Tissue Reconstruction

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Update on the Management of Open Lower Limb Fractures

The Open Orthopaedics Journal ◽

10.2174/1874325001206010571 ◽

2012 ◽

Vol 6 (1) ◽

pp. 571-577 ◽

Cited By ~ 11

Author(s):

M Griffin ◽

M Malahias ◽

W Khan ◽

S Hindocha

Keyword(s):

Soft Tissue ◽

Lower Limb ◽

Team Work ◽

Current Evidence ◽

Optimal Time ◽

Soft Tissue Coverage ◽

Current Recommendation ◽

Lower Limb Fractures ◽

Vascular Compromise ◽

Limb Fractures

Open lower limb fractures pose a significant challenging pathology for orthopaedic and plastic surgeons to manage due to the combined soft tissue damage, bone loss and potential vascular compromise. These fracture require extensive team-work and expertise between several surgical specialties and the advice of non-surgical specialties to ensure good clinical outcomes. Extensive research has improved the outcomes of open lower limb fractures and current recommendation on the optimal management is always being updated to enhance patient outcomes. This review serves to provide an overview of the management of open tibial fractures using current evidence and recently updated UK guidelines. The optimal time for surgical debridement, surgical intervention, providing antibiotics and soft tissue coverage will be outlined as well as the indications for amputation.

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Update on the Management of Compound Lower Limb Fractures

The Open Orthopaedics Journal ◽

10.2174/1874325001206010518 ◽

2012 ◽

Vol 6 (1) ◽

pp. 518-524 ◽

Cited By ~ 7

Author(s):

M Griffin ◽

M Malahias ◽

S Hindocha ◽

W Khan

Keyword(s):

Soft Tissue ◽

Lower Limb ◽

Team Work ◽

Current Evidence ◽

Optimal Time ◽

Soft Tissue Coverage ◽

Current Recommendation ◽

Lower Limb Fractures ◽

Bone Injury ◽

Limb Fractures

Compound lower limb fractures pose a significant challenging pathology for orthopaedic and plastic surgeons to manage due to the combined soft tissue damage, bone injury and potential vascular compromise. These fractures require extensive team-work and expertise between several surgical specialties and the advice of non-surgical specialties, to ensure good clinical outcomes. Extensive research has improved the outcomes of compound lower limb fractures and current recommendation on the optimal management is always being updated to enhance patient outcomes. This review serves to provide an overview of the management of compound tibial fractures using current evidence and recently updated UK guidelines. The optimal time for surgical debridement, surgical intervention, antibiotic regime and soft tissue coverage will be outlined as well as the indications for amputation.

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Motorcyclists and pillion passengers with open lower-limb fractures: a study using TARN data 2007–2014

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2017.0222 ◽

2018 ◽

Vol 100 (3) ◽

pp. 203-208 ◽

Cited By ~ 2

Author(s):

AGC Hay-David ◽

T Stacey ◽

I Pallister ◽

Keyword(s):

Soft Tissue ◽

Lower Limb ◽

Research Network ◽

Soft Tissue Coverage ◽

Patient Movement ◽

Lower Limb Fractures ◽

Number Of Patients ◽

Limb Fractures ◽

The Impact ◽

Time From Injury

Introduction We aimed to identify population demographics of motorcyclists and pillion passengers with isolated open lower-limb fractures, to ascertain the impact of the revised 2009 British Orthopaedic Association/British Association of Plastic Reconstructive and Aesthetic Surgeons joint standards for the management of open fractures of the lower limb (BOAST 4), in terms of time to skeletal stabilisation and soft-tissue coverage, and to observe any impact on patient movement. Methods Retrospective cohort data was collected by the Trauma Audit and Research Network (TARN). A longitudinal analysis was performed between two timeframes in England (pre-and post-BOAST 4 revision): 2007–2009 and 2010–2014. Results A total of 1564 motorcyclists and 64 pillion passengers were identified. Of these, 93% (1521/1628) were male. The median age for males was 30.5 years and 36.7 years for females. There was a statistically significant difference in the number of patients who underwent skeletal stabilisation (49% vs 65%, P < 0.0001), the time from injury to skeletal stabilisation (7.33 hours vs 14.3 hours, P < 0.0001) and the proportion receiving soft-tissue coverage (26% vs 43%, P < 0.0001). There was no difference in the time from injury to soft-tissue coverage (62.3 hours vs 63.7 hours, P = 0.726). The number of patients taken directly to a major trauma centre (or its equivalent) increased between the two timeframes (12.5% vs, 41%, P < 0.001). Conclusions Since the 2009 BOAST 4 revision, there has been no difference in the time taken from injury to soft-tissue coverage but the time from injury to skeletal stabilisation is longer. There has also been an increase in patient movement to centres offering joint orthopaedic and plastic care.

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