A review of forty five open tibial fractures covered with free flaps. Analysis of complications, microbiology and prognostic factors

Olesen, Ulrik Kähler; Juul, Rasmus Vestergaard; Bonde, Christian; Moser, Claus; McNally, Martin; Jensen, Lisa Toft; Elberg, Jens Jørgen; Eckardt, Henrik

doi:10.1007/s00264-015-2712-z

Cited by 50 publications

(38 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A major perceived advantage is that soft tissue coverage can be delayed until the wound is no longer infected. However, the evidence suggests that delay with NPWT risks superinfection 45 and skin flora microorganisms can migrate into the wound and adhere to internal fixation material, leading to nonunion or recurrent infection. 46 Furthermore, this approach leads to multiple unnecessary operations and cost.…”

Section: Principles Of Surgical Treatmentmentioning

confidence: 99%

Management of Post-Traumatic Osteomyelitis in the Lower Limb: Current State of the Art

Chan

Ferguson

Scarborough

et al. 2019

Indian J Plast Surg

View full text Add to dashboard Cite

Osteomyelitis (OM) of the lower limb represents a large unmet global healthcare burden. It often arises from a contiguous focus of infection and is a recognized complication of open fractures or their surgical treatment, arthroplasty, and diabetic foot ulcers. Historically, this debilitating condition is associated with high rates of recurrence and secondary amputation. However, excellent long-term outcomes are now achieved by adopting a multidisciplinary approach with meticulous surgical debridement, skeletal and soft tissue reconstruction, and tailored antimicrobial treatment. This review focuses on the modern evidence-based management of post-traumatic OM in the lower limb from a reconstructive plastic surgery perspective, highlighting the latest developments and areas of controversy.

show abstract

Section: Principles Of Surgical Treatmentmentioning

confidence: 99%

Management of Post-Traumatic Osteomyelitis in the Lower Limb: Current State of the Art

Chan

Ferguson

Scarborough

et al. 2019

Indian J Plast Surg

View full text Add to dashboard Cite

show abstract

“…These conditions include severe infection and local vascular problems. In the presence of infection the chance for success of plastic surgery is limited and additional surgery may be required to control infection prior to the major plastic surgery[5,14,15]. After severe trauma some limbs may be left with only one blood vessel and if it is used as a feeding artery for the graft this may threaten the limb life.…”

Section: Discussionmentioning

confidence: 99%

Unhappy triad in limb reconstruction: Management by Ilizarov method

El-Alfy

2017

WJO

View full text Add to dashboard Cite

AIMTo evaluate the results of the Ilizarov method in management of cases with bone loss, soft tissue loss and infection.METHODSTwenty eight patients with severe leg trauma complicated by bone loss, soft tissue loss and infection were managed by distraction osteogenesis in our institution. After radical debridement of all the infected and dead tissues the Ilizarov frame was applied, corticotomy was done and bone transport started. The wounds were left open to drain. Partial limb shortening was done in seven cases to reduce the size of both the skeletal and soft tissue defects. The average follow up period was 39 mo (range 27-56 mo).RESULTSThe infection was eradicated in all cases. All the soft tissue defects healed during bone transport and plastic surgery was only required in 2 cases. Skeletal defects were treated in all cases. All patients required another surgery at the docking site to fashion the soft tissue and to cover the bone ends. The external fixation time ranged from 9 to 17 mo with an average of 13 mo. The complications included pin tract infection in 16 cases, wire breakage in 2 cases, unstable scar in 4 cases and chronic edema in 3 cases. According to the association for study and application of methods of Ilizarov score the bone results were excellent in 10, good in 16 and fair in 2 cases while the functional results were excellent in 8, good in 17 and fair in 3 cases.CONCLUSIONDistraction osteogenesis is a good method that can treat the three problems of this triad simultaneously.

show abstract

“…For open fractures with severe soft tissue damage, skin closure might necessitate a plastic surgical procedure using a free flap to restore the damage. In these cases, early skin closure (within a week after trauma) has a positive effect on infection rates [115]. Awaiting soft tissue coverage and preventing the wound-bed from being bacterially colonised, which might potentiate infection, demand that the would be covered.…”

Section: Surgical Debridement and Irrigationmentioning

confidence: 99%

Prevention of fracture-related infection: a multidisciplinary care package

Metsemakers

Onsea

Neutjens

et al. 2017

International Orthopaedics (SICOT)

Self Cite

View full text Add to dashboard Cite

Fracture-related infection (FRI) remains a challenging complication. It may result in permanent functional loss or even amputation in otherwise healthy patients. For these reasons, it is important to focus attention on prevention. In treatment algorithms for FRI, antibiotic stewardship programmes have already proved their use by means of a multidisciplinary collaboration between microbiologists, surgeons, pharmacists, infectious disease physicians and nursing staff. A similar approach, however, has not been described for infection prevention. As a first step towards achieving a multidisciplinary care package for infection prevention, this review summarises the most recent guidelines published by the World Health Organization (WHO) and US National Institutes of Health Centers for Disease Control and Prevention (CDC), primarily focusing on the musculoskeletal trauma patient. The implementation of these guidelines, together with close collaboration between infection control physicians, surgeons, anaesthesiologists and nursing staff, can potentially have a beneficial effect on the rate of FRI after musculoskeletal trauma surgery. It must be stated that most evidence presented here in support of these guidelines was not obtained from musculoskeletal trauma research. Although most preventive measures described in these studies can be generalised to the musculoskeletal trauma patient, there are still important differences with nontrauma patients that require further attention. Future research should therefore focus more on this very defined patient population and more specifically on FRI prevention.

show abstract

A review of forty five open tibial fractures covered with free flaps. Analysis of complications, microbiology and prognostic factors

Abstract: Flap cover within one week is essential to avoid infection. High-energy trauma and smoking are important predictors of complications. We suggest antibiotic prophylaxis with vancomycin and meropenem until the wound is covered in these complex injuries.

Cited by 50 publications

References 23 publications

Management of Post-Traumatic Osteomyelitis in the Lower Limb: Current State of the Art

Management of Post-Traumatic Osteomyelitis in the Lower Limb: Current State of the Art

Unhappy triad in limb reconstruction: Management by Ilizarov method

Prevention of fracture-related infection: a multidisciplinary care package

Contact Info

Product

Resources

About