Management of the soft tissues in open tibial fractures

Small, J.O.; Mollan, R. A. B.

doi:10.1016/0007-1226(92)90022-p

Cited by 67 publications

(34 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our 10% primary amputation rate in this group is far below the actual rate, considering the total number of injured limbs, because only borderline cases for amputation as well as other complex wounds were referred to us, and we performed primary amputations among these selected patients. A primary amputation rate of 8% was reported by Small and Mollan 20 among 168 open tibial fractures caused mainly by road traffic accidents. The relatively high rate of primary amputations and the younger age of our patients were the most important factors in avoiding serious systemic complications and mortality.…”

Section: Discussionmentioning

confidence: 97%

Subacute reconstruction of lower leg and foot defects due to high velocity-high energy injuries caused by gunshots, missiles, and land mines

et al. 2005

View full text Add to dashboard Cite

The present study reviews 215 male patients suffering high velocity-high energy injuries of the lower leg or foot caused by war weapons such as missiles, gunshots, and land mines. They were treated in the Department of Plastic and Reconstructive Surgery at Gulhane Military Medical Academy (Ankara, Turkey) between November 1993-January 2001. Severe soft-tissue defects requiring flap coverage and associated open bone fractures that were treated 7-21 days (mean, 9.6 days) after the injury were included in the study. Twenty-three of 226 extremities (10.2%) underwent primary below-knee amputation. The number of debridements prior to definitive treatment was between 1-3 (mean, 1.9). Gustilo type III open tibia fractures accompanied 104 of 126 soft-tissue defects of the lower leg. Sixty-four bone defects accompanied 83 soft-tissue defects of the feet. Eighteen local pedicled muscle flaps and 208 free muscle flaps (latissimus dorsi, rectus abdominis, and gracilis) were used in soft-tissue coverage of 209 defects. Overall, the free muscle flap success rate was 91.3%. Bone defects were restored with 106 bone grafts, 25 free fibula flaps, and 14 distraction osteogenesis procedures. Osseous and soft-tissue defects were reconstructed simultaneously at the first definitive treatment in 94% of cases. The mean follow-up after definitive treatment was 25 (range, 9-47) months. The average full weight-bearing times for lower leg and feet injuries were 8.4 months and 4 months, respectively. Early, aggressive, and serial debridement of osseous and soft tissue, early restoration of bone and soft-tissue defects at the same stage, intensive rehabilitation, and patient education were the key points in the management of high velocity-high energy injuries of the lower leg and foot.

show abstract

Section: Discussionmentioning

confidence: 97%

Subacute reconstruction of lower leg and foot defects due to high velocity-high energy injuries caused by gunshots, missiles, and land mines

et al. 2005

View full text Add to dashboard Cite

show abstract

“…Coverage within a week, and considerably sooner in some studies, has been shown to produce fracture union sooner, have a lower infection rate and require fewer operative procedures [18][19][20]. The Guidelines of the British Association of Plastic, Reconstructive and Aesthetic Surgeons and British Orthopaedic Association support this in recommending soft-tissue reconstruction within seven days of injury [21].…”

Section: Principles Of Reconstruction (A) Timing Of Reconstructionmentioning

confidence: 99%

Shaping the military wound: issues surrounding the reconstruction of injured servicemen at the Royal Centre for Defence Medicine

Evriviades

Jeffery

Cubison³

et al. 2011

Phil. Trans. R. Soc. B

View full text Add to dashboard Cite

The conflict in Afghanistan has produced injuries similar to those produced from military conflicts for generations. What distinguishes the modern casualty of the conflict in Afghanistan from those of other conflicts is the effectiveness of modern field medical care that has led to individuals surviving with injuries, which would have been immediately fatal even a few years ago. These patients present several challenges to the reconstructive surgeon. These injured individuals present early challenges of massive soft-tissue trauma, unstable physiology, complex bony and soft-tissue defects, unusual infections, limited reconstructive donor sites, peripheral nerve injuries and traumatic amputations. Late challenges to rehabilitation include the development of heterotopic ossification in amputation stumps. This paper outlines the approach taken by the reconstructive team at the Royal Centre for Defence Medicine in managing these most difficult of reconstructive challenges.

show abstract

“…Several clinical studies have addressed the outcome of complex open tibial fractures, with regard to soft tissue coverage, although no controlled trials have been performed comparing muscle and fasciocutaneous tissue. Muscle has been preferred, 9,[12][13][14][15] although outcomes were similar when muscle and fasciocutaneous flaps have been used in patients. 16 In a rodent flank infection model, muscle was found to be superior to fasciocutaneous tissue in reducing bacterial load.…”

mentioning

confidence: 99%

Comparison of the healing of open tibial fractures covered with either muscle or fasciocutaneous tissue in a murine model

Harry

Sandison

Paleolog

et al. 2008

Journal Orthopaedic Research

133

113

View full text Add to dashboard Cite

The objective of this study was to compare the effects of soft tissue coverage by either muscle or fasciocutaneous tissue on the healing of open tibial fractures in a murine model. An open tibial fracture, stripped of periosteum with intramedullary fixation, was created in mice. Experimental groups were devised to allow exclusive comparison of either muscle alone or skin plus fascia in direct contact with healing bone. To exclusively assess the relative efficacy of muscle and fasciocutaneous tissue to promote healing of a fracture stripped of periosteum, a piece of sterile inert material (polytetrafluoroethylene) was positioned anteriorly, excluding skin and fascia (muscle group) or posteriorly, excluding muscle (fasciocutaneous group). Skeletal repair was assessed histologically and quantified by histomorphometry; quantitative peripheral computed tomography (pQCT) and mechanical testing using a four-point bending technique. This standardized, reproducible model allowed characterization of the morphology of open fracture healing. At 28 days postfracture, there was faster healing in the experimental muscle coverage group compared to skin and fascia alone. Furthermore, there was almost 50% more cortical bone content and a threefold stronger union beneath muscle compared to fasciocutaneous tissue (p < 0.05 by one-way ANOVA). Exclusive comparison of muscle and fasciocutaneous tissue in our novel murine model demonstrates that muscle is superior for the coverage of open tibial fractures for both the rate and quality of fracture healing. ß

show abstract

Management of the soft tissues in open tibial fractures

Cited by 67 publications

References 21 publications

Subacute reconstruction of lower leg and foot defects due to high velocity-high energy injuries caused by gunshots, missiles, and land mines

Subacute reconstruction of lower leg and foot defects due to high velocity-high energy injuries caused by gunshots, missiles, and land mines

Shaping the military wound: issues surrounding the reconstruction of injured servicemen at the Royal Centre for Defence Medicine

Comparison of the healing of open tibial fractures covered with either muscle or fasciocutaneous tissue in a murine model

Contact Info

Product

Resources

About