Primäres Weichteilmanagement bei offenen Frakturen

Riechelmann, Felix; Kaiser, Peter; Arora, Rohit

doi:10.1007/s00064-018-0562-8

Cited by 16 publications

(6 citation statements)

References 47 publications

(11 reference statements)

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“…[ 21 ] When the body is weak or the local blood transport is poor, the latent bacteria will multiply rapidly and lead to incisional infection. [ 22 ] Therefore, open fractures should be debrided as early as possible, and those with more serious injuries should be debrided in the operating room, while removing soft tissues that have lost blood flow and removing foreign bodies.…”

Section: Discussionmentioning

confidence: 99%

Construction and validation of a nomogram prediction model for postoperative incisional infection in ankle fractures

Deng

2023

Medicine

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The aim was to investigate the independent risk factors for postoperative incisional infection in ankle fractures and to establish a nomogram prediction model accordingly. Data were collected from ankle fracture patients in the Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2022. Univariate and multivariate logistic regression analyses were used to determine the independent risk factors for postoperative incisional infection in ankle fractures and to establish the corresponding nomogram. Receiver operating characteristic curves were plotted and area under the curve was calculated, and calibration curves and decision curve analysis were plotted to evaluate the model performance. A total of 722 patients with ankle fractures were included in the study, and 76 patients developed postoperative incisional infections, with an incidence of 10.53%. After univariate and multivariate logistic regression analysis, a total of 5 variables were identified as independent risk factors for postoperative incisional infection in ankle fractures, namely, age ≥ 60 years (OR, 1.885; 95% CI, 1.156–3.045), having diabetes (OR1.625; 95% CI, 1.095–2.876), open fracture (OR, 5.564; 95% CI, 3.099–9.990), albumin < 35 g/L (OR, 2.618; 95% CI, 1.217–4.215), and operative time ≥ 2 hours (OR, 1.606; 95% CI, 1.077–3.247). The nomogram for postoperative incisional infection after ankle fracture constructed in this study has good predictive accuracy and helps orthopedic surgeons to intervene earlier in patients at high risk of postoperative incisional infection after ankle fracture.

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Section: Discussionmentioning

confidence: 99%

Construction and validation of a nomogram prediction model for postoperative incisional infection in ankle fractures

Deng

2023

Medicine

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“…Orthopedic or emergency surgery is often used in the early stage of lower limb trauma [7 -10] ,some patients have primary injuries, such as electric burn, severe rolling of skin and soft tissue, vascular injury or local hematoma, fat liquefaction, hematoma infection, etc., which eventually develop into skin necrosis [11][12][13] ;…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Therapeutic Effect of Artificial Leather Embedding Combined with Fascial Sleeve Flap Transplantation on Chronic Wounds of Lower Limbs with Bone and Plate Exposure

Zhang

Liu

et al. 2022

Preprint

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Background: After severe trauma of lower limbs, bone、tendon or plate graft exposure is common.The traditional repair method is to use a variety of skin flap transplantation to cover the exposed part, but the wound often can not heal after operation, or the wound is cracked, ulcer, sinus, bone and steel plate are exposed again after wound healing.The reason for this result is that when the flap is covered, the space around the bone plate is not well closed, forming a dead cavity, blood and exudate accumulation, hematoma formation or infection, and finally the wound ruptures again. In addition, due to the swelling and contracture of the flap after operation, the suture tension between the flap and the receiving area becomes larger, the skin becomes thinner and broken, and then the wound is formed. In order to solve the above problems, we carried out the study of artificial true skin embedding combined with fascial sleeve flap transplantation in the treatment of chronic bone plate exposed wounds of lower limbs.Methods: In this paper, 11 cases of chronic wounds with bone exposure and skin necrosis after steel plate implantation were selected. First stage is the wound bed preparation including primary wound expansion,removal of necrotic tissue and incision of sinus wall, removal of deep necrotic bone and fibrotic scarred skin on the outer wall of steel plate to normal tissue on the outer edge of the wound, removal of precipitated peptone and purulent fur in the hole, periphery and bone space of the steel plate, and removal of tendon tissue with basal necrosis and disintegration of the wound. After vacuum sealing drainage (VSD) 1~2 weeks, the peritraumatic basal granulation tissue grew well and there was no necrotic tissue in the wound. In the second stage, the exposed bone was covered with artificial dermis, the steel plate hole or the periphery and the basal space were filled, and the exposed steel plate was completely embedded, and then the fascia sleeve flap was transplanted to cover the wound. The sural neurovascular flap was performed in 9 cases and the lateral superior malleolar artery perforator flap in 2 case. Results: The flap survived well in all 11 cases. During the follow-up of 6 months to the removal of the plate, there was no case of rupture, exposure and sinus formation.Conclusions: Artificial dermal covering combined with fascial sleeve flap transplantation can effectively avoid wound dehiscence or sinus formation caused by foreign body retention, infection and flap contracture,It has good effect in repairing chronic wounds with bone plate exposure after severe trauma of lower limbs.

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“…The early stage of lower limb trauma is mostly treated by orthopaedics or emergency surgery [7]- [10] .Some patients have primary injuries such as such as electric burn, severe rolling of skin and soft tissue, vascular injury, or local hematoma , fat liquefaction and hematoma infection which eventually develop into skin necrosis [11]- [13] ; For patients with fracture, plate internal xation is a more common method. However, a lot of in ammatory exudate accumulate in the wound in some patients because of postoperative skin tissue swelling, excessive shear tension, skin necrosis or incision dehiscence or secondary wound infection, osteomyelitis.…”

Section: Discussionmentioning

confidence: 99%

Application of Artificial Dermal Graft Combined with Fascia Sleeve Flap in the Treatment of Chronic Bone and Steel Plate Exposed Wounds of Lower Extremities

Zhang

Liu

et al. 2021

Preprint

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Background:Bone tendon or graft exposure such as steel plate is common after severe trauma of lower extremity.The traditional repair method is to use a variety of skin flaps to cover the exposure, but the wound can not heal after operation, or the wound dehiscence, ulcer, sinus, etc. occur again after short healing, and the bone plate is exposed again.The reason for this result is that the space around the bone plate is not well closed when the flap is covered，dead space is formed, blood and exudate accumulate, hematoma forms or infection occurs, and finally the wound breaks.Also due to swelling and contracture after flap operation,the tension of the suture between the flap and the receiving area is too large and becomes thin and cracked, forming an exposed state.In order to solve the above problems, we have carried out the research on "Application of artificial gradient combined with fascia sleep flap in the treatment of chronic bone and steel plate exposed woods of lower extremes".Methods:In this paper, 11 cases of chronic wounds with bone exposure and skin necrosis after steel plate implantation were selected. First stage is the wound bed preparation including primary wound expansion,removal of necrotic tissue and incision of sinus wall, removal of deep necrotic bone and fibrotic scarred skin on the outer wall of steel plate to normal tissue on the outer edge of the wound, removal of precipitated peptone and purulent fur in the hole, periphery and bone space of the steel plate, and removal of tendon tissue with basal necrosis and disintegration of the wound. After vacuum sealing drainage (VSD) 1~2 weeks, the peritraumatic basal granulation tissue grew well and there was no necrotic tissue in the wound. In the second stage, the exposed bone was covered with artificial dermis, the steel plate hole or the periphery and the basal space were filled, and the exposed steel plate was completely embedded, and then the fascia sleeve flap was transplanted to cover the wound. The sural neurovascular flap was performed in 6 cases and the lateral superior malleolar artery perforator flap in 1 case. Results:The flap survived well in all 11 cases. During the follow-up of 6 months to the removal of the plate, there was no case of rupture, exposure and sinus formation.Conclusions:Artificial dermal covering combined with fascial sleeve flap transplantation can effectively avoid wound dehiscence or sinus formation caused by foreign body retention, infection and flap contracture,It has good effect in repairing chronic wounds with bone plate exposure after severe trauma of lower limbs,.

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Primäres Weichteilmanagement bei offenen Frakturen

Cited by 16 publications

References 47 publications

Construction and validation of a nomogram prediction model for postoperative incisional infection in ankle fractures

Construction and validation of a nomogram prediction model for postoperative incisional infection in ankle fractures

Analysis of the Therapeutic Effect of Artificial Leather Embedding Combined with Fascial Sleeve Flap Transplantation on Chronic Wounds of Lower Limbs with Bone and Plate Exposure

Application of Artificial Dermal Graft Combined with Fascia Sleeve Flap in the Treatment of Chronic Bone and Steel Plate Exposed Wounds of Lower Extremities

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