Microvascular Soft-Tissue Transplantation for Reconstruction of Acute Open Tibial Fractures

Francel, Thomas J.; Kolk, Craig A. Vander; Hoopes, John E.; Manson, Paul N.; Yaremchuk, Michael J.

doi:10.1097/00006534-199203000-00014

Cited by 232 publications

(123 citation statements)

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“…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

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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.

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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

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“…The high energy often imparted to the fracture site disrupts the soft tissue envelope and strips the periosteum predisposing to impaired healing and infection. 1,2 Recovery can be prolonged, 3,4 with the time to fracture union delayed compared to closed fractures. [4][5][6][7] The relatively exposed subcutaneous position of the tibia means that it is particularly prone to such trauma, where substantial loss of overlying soft tissues, periosteal stripping, and bone exposure are described as Gustilo IIIB injuries.…”

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

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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

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“…Most of our cases followed road traffic accidents with severe crush injuries leading to limb not salvaged subjected to amputation either primarily or after failed attempt of salvage. Previous studies have acknowledged that salvaged limbs have more operation and late return to work than properly amputated cases of mangled extremity [7,8] . Recent studies have insisted on reconstruction attempts of the limb and deferred amputations [9] .…”

Section: Discussionmentioning

confidence: 99%

Incidence and type of complications following traumatic extremity amputations: preliminary report from a teaching hospital

Dharmshaktu¹,

Singh²,

Bhandari³

et al. 2018

Int. J. Orthop. Sci.

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Amputation is one of the oldest surgical procedure and a good amputation results in optimal functional outcome by providing healthy residual limb. Advances in prosthetics has enabled amputee with diverse options and better functionality. There is also decrease in the overall burden of amputation as a result of better treatment of causative disorders and proper limb salvage techniques. Complications, however, pose challenges in regain of necessary functions and include an array of disorders related to the procedure, technique and other factors. An understanding of common and practical complications is helpful in their anticipation and relevant prohibitive measures. Apart from it, a comprehensive study that highlights pattern of amputations and related complications provides database for preventive and management strategy. A total of 69 cases of extremity amputations were included within a defined period of Jan 2011 to June 2016. Relevant demographic data were noted along with other details amputation and complications. An attempt is also made for co-morbidities associated in cases with complications. Males (88.40%) and lower extremity (66.66%) were involved more commonly than females and upper extremity. Below knee was commonest (50.72%) lower and below elbow along with digital amputations were commonest (15.94% each) upper extremity amputations. The significant complication that required increased hospital stay or additional procedures were noted in 34 (49.27%) cases. Delayed wound healing, wound dehiscence, painful neuroma, stiffness, exposed bone and phantom pain were some of major complication noted in the study. A brief notes on patient characteristics has been attributed to the nature of trauma, co-morbidities and substance abuse among the complicated cases. The early recognition of complication and prompt management goes a long way in abetment of agony and discomfort of patient affecting overall outcome.

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Microvascular Soft-Tissue Transplantation for Reconstruction of Acute Open Tibial Fractures

Cited by 232 publications

References 0 publications

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

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

Incidence and type of complications following traumatic extremity amputations: preliminary report from a teaching hospital

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