Effects of a formalized collaboration between plastic and orthopedic surgeons in severe extremity trauma patients; a retrospective study

Sommar, Pehr; Granberg, Yamin; Halle, Martin; Skogh, A.C. Docherty; Lundgren, Kalle T.; Jansson, Karl Åke

doi:10.1186/s13032-015-0023-4

Cited by 30 publications

(37 citation statements)

References 14 publications

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“…A total of 1663 orthoplastic managed patients and 692 nonorthoplastic managed patients with traumatic lower extremity injuries were managed at an MTC. Six studies were retrospective, 12 , 15 – 17 , 19 , 20 2 were prospective, 13 , 18 and 1 consisted of a prospective orthoplastic cohort and retrospective nonorthoplastic cohort. 14 Eight before-and-after studies compared orthoplastic management at the same MTC.…”

Section: Resultsmentioning

confidence: 99%

The Value of an Orthoplastic Approach to Management of Lower Extremity Trauma: Systematic Review and Meta-analysis

Klifto

Azoury

Othman

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Management of traumatic lower extremity injuries requires a skill set of orthopedic surgery and plastic surgery to optimize the return of form and function. A systematic review and meta-analysis was performed comparing demographics, injuries, and surgical outcomes of patients sustaining lower extremity traumatic injuries receiving either orthoplastic management or nonorthoplastic management. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analysis, Cochrane, and GRADE certainty evidence guidelines were implemented for the structure and synthesis of the review. PubMed, Embase, Cochrane Library, Web of Science, Scopus, and CINAHL databases were systematically and independently searched. Nine studies published from 2013 through 2019 compared 1663 orthoplastic managed patients to 692 nonorthoplastic managed patients with traumatic lower extremity injuries. Results: Orthoplastic management, compared to nonorthoplastic management likely decreases time to bone fixation [standard mean differences: −0.35, 95% confidence interval (CI): −0.46 to −0.25, P < 0.0001; participants = 1777; studies = 3; I 2 = 0%; moderate certainty evidence], use of negative pressure wound therapy [risk ratios (RR): 0.03, 95% CI: 0.00–0.24, P = 0.0007; participants = 189; studies = 2; I 2 = 0%; moderate certainty evidence] with reliance on healing by secondary intention (RR: 0.02, 95% CI: 0.00–0.10, P < 0.0001; participants = 189; studies = 2; I 2 = 0%; moderate certainty evidence), and risk of wound/osteomyelitis infections (RR: 0.37, 95% CI: 0.23–0.61, P < 0.0001; participants = 224; studies = 3; I 2 = 0%; moderate certainty evidence). Orthoplastic management likely results in more free flaps compared to nonorthoplastic management (RR: 3.46, 95% CI: 1.28–9.33, P = 0.01; participants = 592; studies = 5; I 2 = 75%; moderate certainty evidence). Conclusion: Orthoplastic management of traumatic lower extremity injuries provides a synergistic model to optimize and expedite definitive skeletal fixation and free flap-based soft-tissue coverage for return of extremity form and function.

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Section: Resultsmentioning

confidence: 99%

The Value of an Orthoplastic Approach to Management of Lower Extremity Trauma: Systematic Review and Meta-analysis

Klifto

Azoury

Othman

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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“…Complex lower limb injuries should be referred to level 1 trauma centers managed in multidisciplinary collaboration (Naique et al 2006 , Sommar et al 2015 ). In Sweden, most local or regional hospitals have some collaboration with a university hospital with access to both plastic and orthopedic surgeons.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic position is associated with surgical treatment of open fractures of the lower limb: results from a Swedish population-based study

2020

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Background and purpose — High-energy trauma to the lower limbs can result in open fractures, treated by reconstructive surgery or amputation. We examined whether socioeconomic position is associated with choice of primary treatment. Patients and methods — We performed a nationwide population-based study using the Swedish National Patient Register to identify all adult patients who between 1998 and 2013 underwent reconstruction or amputation after an open fracture below the knee. Information on socioeconomic position was collected from Statistics Sweden. Results — Of 275 individuals undergoing surgery after an open fracture below the knee during the study period, the 1st surgery was reconstructive in 58% of the patients and amputation in 42%. The chance of having an initial reconstruction was lower for women than for men (OR 0.5, 95% CI 0.3–0.9), lower with age (OR 0.97, CI 0.96–0.99), and lower for individuals without employment compared with individuals in employment (OR 0.3, CI 0.2–0.5). Primary treatment was in women associated with family composition, whereas in men it was associated with level of education. Interpretation — Choice of primary treatment after open fracture in the lower limb is affected by socioeconomic position including sex, age, employment, family composition, level of education, and income.

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“…26 Measures such as pain, time to definitive skeletal stabilization/ soft tissue coverage, function, length of hospital stay, postoperative complications, and need for revision procedures are improved with this approach. 41,43,44 In cases of pediatric lower extremity trauma with vascular compromise, the implementation of protocols that necessitate early triage by a microvascular surgeon improves response time and appropriate treatment. 42 Dedicated operating sessions with plastic and orthopaedic surgeons for patients with open fractures and complex soft tissue injuries also decreases timing to soft tissue coverage.…”

Section: Orthoplastic Approach Leads To Improved Outcomesmentioning

confidence: 99%

Principles of Orthoplastic Surgery for Lower Extremity Reconstruction: Why Is This Important?

Azoury

Stranix

Kovach

et al. 2019

J Reconstr Microsurg

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Background Regardless of the antecedent etiology, lower extremity salvage and reconstruction attempts to avoid amputation, restore limb function, and improve quality of life outcomes. This goal requires a treatment team well versed in neurovascular pathology, skeletal and soft tissue reconstruction, and physical rehabilitation. Methods A review was performed of historical milestones that lead to the development of orthoplastic extremity reconstruction, principles of current management and the evidence that supports an orthoplastic approach. Based on available evidence and expert opinion, the authors further sought to provide insight into the future of the field centered around the importance of a multidisciplinary management protocol. Results Historically, orthopaedic and plastic surgeons worked separately when faced with challenging reconstructive cases involving lower extremity skeletal and soft tissue reconstruction. With time, many embraced that their seemingly separate skill-sets and knowledge could be unified in a collaborative orthoplastic approach in order to offer patients the best possible chance for success. First coined by the senior author (LSL) in the early 1990s, the collaborative orthoplastic approach between orthopaedic and plastic surgeons in limb salvage for the past several decades has resulted in a unique field of reconstructive surgery. Benefits of the orthoplastic approach include decreased time to definitive skeletal stabilization/soft tissue coverage, length of hospital stay, post-operative complications, need for revision procedures and improved functional outcomes. Conclusion The orthoplastic approach to lower extremity reconstruction is a collaborative model of orthopaedic and plastic surgeons working together to expedite and optimize care of patients in need of lower extremity reconstruction. The implementation of protocols, systems, and centers that foster this approach leads to improve outcomes for these patients. We encourage centers to embrace the orthoplastic approach when considering limb salvage, as the decision to amputate is irreversible.

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Effects of a formalized collaboration between plastic and orthopedic surgeons in severe extremity trauma patients; a retrospective study

Cited by 30 publications

References 14 publications

The Value of an Orthoplastic Approach to Management of Lower Extremity Trauma: Systematic Review and Meta-analysis

The Value of an Orthoplastic Approach to Management of Lower Extremity Trauma: Systematic Review and Meta-analysis

Socioeconomic position is associated with surgical treatment of open fractures of the lower limb: results from a Swedish population-based study

Principles of Orthoplastic Surgery for Lower Extremity Reconstruction: Why Is This Important?

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