One-stage combined “fix and flap” approach for complex open Gustilo–Anderson IIIB lower limbs fractures: a prospective review of 102 cases

Aljawadi, Ahmed; Islam, Amirul; Jahangir, Noman; Niazi, Noman; Elmajee, Mohammed; Reid, Adam J.; Wong, Jason; Pillai, Anand

doi:10.1007/s00402-020-03705-y

Cited by 13 publications

(11 citation statements)

References 32 publications

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“…The inability to eliminate unchangeable causes of delay (e.g. the need for further medical optimization and poly-traumatic presentation) [ 25 ], and the comparable outcomes of patients who had the definitive stabilization and soft tissue cover after 72 hours from injury as in this study and in other studies [ 8 , 9 , 21 ], shows the outweighing importance of achieving a meticulous and simultaneous ortho-plastic approach over focusing on achieving the 72 hours target if the latter leads to a suboptimal definitive operation.…”

Section: Discussionmentioning

confidence: 76%

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Clinical and Radiological Outcomes of Gustilo-Anderson Type IIIB Open Fractures in 125 Patients

Ali¹,

Aljawadi²,

Elkhidir³

et al. 2023

Cureus

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Introduction: This study describes single-centre outcomes of Gustilo-Anderson type IIIB open fractures in relation to the current standards in the United Kingdom, which aim at performing skeletal fixation and soft tissue coverage at an early stage to salvage the limb and achieve bone union with a minimum infection rate.Methods: A total of 125 patients with 134 Gustilo-Anderson type IIIB open fractures, who had definitive skeletal fixation with soft tissue coverage between June 2013 and October 2021, were prospectively followed up and included in this study.Results: Initial debridement was performed within 12 hours from the time of injury for 62 (49.6%) patients and within 24 hours for 119 (95.2%) patients (mean= 12.4 hours). Definitive skeletal fixation and soft tissue coverage were achieved within 72 hours for 25 (20%) patients and within seven days for 71 (57%) patients (mean= 8.5 days). The mean follow-up duration was 43.3 (6-100) months, and the limb salvage rate was 97.1%. The occurrence of deep infections was associated with time from injury to initial debridement (p=0.049). Three patients (2.4%) developed deep (metalwork) infections, all three had their initial debridement performed within 12 hours from the time of injury. There was no association between time to definitive surgery and the development of deep infection (p=0.340). Bone union was achieved in 84.3% of patients following their primary surgery. Time to union was associated with fixation modality (p=0.002) and type of soft tissue coverage (p=0.028), and was negatively correlated with time to initial debridement (p=0.002, correlation coefficient -0.321). There was a 0.27-month decrease in time to union for every hour delay in time to debridement (p=0.021).Conclusion: Delaying initial debridement or definitive fixation and soft tissue coverage didn't increase the rate of deep (metalwork) infections. The time to achieve bone union was negatively correlated with the time from injury to initial debridement. We advise prioritising surgical technique and availability of expertise over strict adherence to time thresholds of surgeries.

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Section: Discussionmentioning

confidence: 76%

“…This study evaluates the outcomes of a combined orthoplastic approach in managing GA type IIIB open fractures in an orthoplastic unit in Manchester, building on a previously published paper in our institution, with a larger sample size and an extended follow-up duration [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical and Radiological Outcomes of Gustilo-Anderson Type IIIB Open Fractures in 125 Patients

Ali¹,

Aljawadi²,

Elkhidir³

et al. 2023

Cureus

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“…The resorbable gentamicin-eluting bone graft substitute used is established in both the preventive use for acute fractures and the treatment of bone defects due to bone infections or (infected) non-unions. 26–28 It allows for an extremely high local gentamicin concentration and is shown to remodel into bone. 19 , 20 …”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Clavicular Fractures, Refractures, Delayed and Non-Unions Using a Resorbable, Gentamicin-Eluting Calcium Sulphate/Hydroxyapatite Biocomposite

Peters¹,

Singh²,

Hakobyan³

2022

TCRM

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Objective This study describes clinical and radiological outcomes following treatment of displaced primary fractures, refractures, delayed unions and non-unions of the clavicle with open reduction and internal fixation (ORIF) with a plate plus filling of the residual bone defect and/or implant augmentation with a gentamicin-loaded bone graft substitute (CERAMENT G, BONESUPPORT). Patients and Methods Patients who underwent surgical treatment either for displaced clavicle fractures, refractures, delayed unions or non-unions between June 2018 and May 2021 were enrolled in this retrospective study. Bony consolidation, complication rate, and functional outcomes, including overall health, were assessed. Results A total of 26 clavicles in 25 patients with a mean age of 50.7 (16–85) years, 16 male and 9 female, were enrolled in the study. The mean follow-up was 14.9 (6–31) months. There were 18 cases of displaced clavicle fractures, four refractures, two delayed unions and two non-unions. The majority of the clavicle lesions were located at the middle third (17/26, 65.4%), seven at the lateral third (26.9%) and two at the medial third (7.7%) of the clavicle. A mean Goldberg score of 7 indicated complete bony union and remodeling of the bone graft substitute in all cases. No complications occurred. The mean University of California at Los Angeles Shoulder Score and the mean Quick Disability of the Arm, Shoulder and Hand Score were 34.6±0.8 (32–35) points and 0.6±1.6 (0–5.4) points, respectively, and revealed excellent functional results. The mean 12-item Short-Form Survey physical component questionnaire was 57.7±1.7 (54.1–58.9) points, and no patient experienced any pain at the last follow-up. Conclusion Our initial experience suggests that ORIF using a plate plus bone defect filling and/or implant augmentation with a gentamicin-eluting bone graft substitute may be useful not only for complication management after clavicle fractures but also in the initial treatment of challenging clavicular fractures.

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“…The utility model had the advantages of fewer operations, shorter treatment cycles, rapid functional recovery, and satisfactory clinical outcomes. 43,44 We believe that the advantages of emergency microsurgical repairs are significant. First, it prevents persistent ischemic necrosis in some tissues.…”

Section: Effect Of the Time From Injury To Flap Coverage On Prognosismentioning

confidence: 99%

Analysis of the Risk Factors for Free Flap Necrosis in Soft Tissue Reconstruction of the Lower Limbs

Líu

et al. 2023

Orthopaedic Surgery

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Objective Free flaps are widely used for the repair of soft tissue defects in the lower limbs, but there is still a specific rate of necrosis. Few clinical retrospective studies have analyzed the nontechnical risk factors for lower limb free flap necrosis. This study aimed to analyze the nontechnical causes of flap necrosis in lower limb soft tissue reconstruction in order to identify risk factors and improve the survival rate of free flaps. Methods Clinical data from 244 cases of soft tissue defects of the leg or foot that were repaired with a free flap from January 2011 to June 2020 were retrospectively analyzed. The flap results were divided into complete survival and necrosis groups. The patients' general information, smoking history, soft tissue defect site, Gustilo‐Anderson classification, shock after injury, type and size of the flap, and time from injury to flap coverage were recorded. A logistic regression model was used to analyze the correlations between flap necrosis and possible risk factors. Results Of the 244 flaps, 32 suffered from partial or total necrosis, and 212 completely survived. Univariate analysis showed that age, smoking history, soft tissue defect site, and time from injury to flap coverage were significantly correlated with flap necrosis (p ≤ 0.2). Multivariate logistic regression analysis showed that moderate‐to‐severe smoking history (p < 0.001, odds ratio [OR] = 10.259, 95% confidence interval [CI] = 2.886–36.468), proximal leg defect (p = 0.006, OR = 7.095, 95% CI = 1.731–29.089), and time from injury to flap coverage >7 days (p = 0.003, OR = 12.351, 95% CI = 2.343–65.099) were statistically significant risk factors for flap necrosis (p < 0.05), and age was excluded (p = 0.666; p = 0.924). Conclusion The risk of flap necrosis was significantly increased when the soft tissue defect was located in the proximal leg, the time from injury to flap coverage was >7 days, and the patient had a moderate‐to‐severe smoking history. These three risk factors have an increased influence on flap necrosis and have guiding significance in predicting flap prognosis.

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One-stage combined “fix and flap” approach for complex open Gustilo–Anderson IIIB lower limbs fractures: a prospective review of 102 cases

Cited by 13 publications

References 32 publications

Clinical and Radiological Outcomes of Gustilo-Anderson Type IIIB Open Fractures in 125 Patients

Clinical and Radiological Outcomes of Gustilo-Anderson Type IIIB Open Fractures in 125 Patients

Surgical Treatment of Clavicular Fractures, Refractures, Delayed and Non-Unions Using a Resorbable, Gentamicin-Eluting Calcium Sulphate/Hydroxyapatite Biocomposite

Analysis of the Risk Factors for Free Flap Necrosis in Soft Tissue Reconstruction of the Lower Limbs

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