Primary versus Delayed Soft Tissue Coverage for Severe Open Tibial Fractures

Cierný, G; BYRD, H. STEVE; Jones, Richard E.

doi:10.1097/00003086-198309000-00008

Cited by 219 publications

(97 citation statements)

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“…The flap failure rate, deep infection rate, and non-union rate of the fractures were lower in the group with early wound coverage. 6 Exposed vital structures, such as vascular grafts, mandate coverage immediately. Some advocate coverage at the time of presentation, before the wound has been heavily colonized with bacteria, 7 others within 6 days.…”

Section: Resultsmentioning

confidence: 99%

Management and outcome in patients with below knee soft tissue injuries

Sachdev¹,

Rajan²,

Dvivedi³

et al. 2018

Int Surg J

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Background: Treatment of lower limb injuries pose a great challenge. Debridement is the key to success in the management of major limb injuries followed by soft-tissue coverage in the form of suturing, skin grafts, or flaps. Our aim is to study the management of various below knee soft tissue injuries.Methods: The study was conducted in the Department of Surgery, Himalayan Institute of Medical Sciences (HIMS), Swami Ram Nagar, Dehradun, over a period of 12 months. Subjects were recruited from patients presenting in Emergency/Surgery OPD, HIMS, Dehradun with a primary diagnosis of below knee soft tissue injuries. A total of 64 patients were included in the study.Results: Primary closure was done in 6 wounds and coverage in rest, with maximum in the form of split skin graft. Abrasion wounds were managed without any surgical intervention. Reconstructive surgery was performed two or more times in 39.06% patients. Local complications were seen in 23.43% of patients and general complications AKI and Tetanus in 2patients.68.75% of patients with local complications were observed to have contaminated wound status at the time of presentation. The average duration of hospital stays ranged between 3 to 56 days. Majority of the patients were discharged within 1 to 3 weeks with mean duration of hospital stay being 17.82±10.95 days.Conclusions: Proper debridement, early coverage of wounds and prompt identification and management of complications is the key to success in the management of lower limb trauma.

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Section: Resultsmentioning

confidence: 99%

Management and outcome in patients with below knee soft tissue injuries

Sachdev¹,

Rajan²,

Dvivedi³

et al. 2018

Int Surg J

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“…[10] Generally, open fractures remain open until the patient returns to the operating room for a secondary debridement to ensure that adequate debridement of necrotic tissue from the wound has been done prior to wound closure. [11] This method recently has been challenged, with authors recommending primary Vol 7, No 3, 2016 closure of open wounds in some cases. Shtarker et al [12] used successfully primary suturing and Illizarov's fi xation in the treatment of open tibial fractures.…”

Section: Discussionmentioning

confidence: 99%

Outcome of application of primary versus secondary Illizarov's fixator in open tibial shaft fractures

Joshi¹,

Singh

Jain

et al. 2016

World Journal of Emergency Medicine

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BACKGROUND:The present study aimed to compare outcome of primary and secondary Illizarov's fi xator application as a treatment method for type III open tibial fractures in terms of nonunion and wound infection. METHODS:This prospective study was done in a tertiary care center. Forty-eight type III tibial fractures were treated with Illizarov's apparatus between 2008 and 2011. The patients were divided into two groups depending on the treatment protocol, timing of wound closure and Illizarov's application, primary (n=28) and secondary (n=20). RESULTS:In the primary group, healing was achieved in all 28 patients. The median time to recovery was 24 weeks, and the median number of operations was 3. There were 6 patients with a bone defect. In the secondary group, complete recovery was achieved in 18 out of 20 patients. The median time to recovery was 30 weeks, and the median number of operations 5. There were 9 patients with a bone defect. The median time to recovery and the number of operations were signifi cantly smaller in patients undergoing primary operation. Union was 100% in the primary group and more than 95% in the secondary group. Chronic osteomyelitis persisted in one patient and below amputation was done in one patient in the secondary group.CONCLUSION: Primary wound closure and Illizarov's fixation required a smaller number of operations and shorter time to recovery than secondary wound closure and Illizarov's fi xation, mostly due to a signifi cantly less number of patients with a bone defect in the primary group.

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“…Los colgajos libres fasciocutá-neos más frecuentes son: el inguinal, el anterolateral del muslo y el lateral del brazo, pero su desventaja es que se relacionan con una elevada morbilidad estética en el área donante cuando son usados para cubrir grandes extensiones, ya que su cierre primario es posible solo cuando son pequeños. [1][2][3] El colgajo paraescapular está basado en la arteria cutánea paraescapular, rama de la arteria circunfleja escapular; su anatomía vascular fue descrita por Saijo, en 1978, 4 y el primer reporte publicado del uso de este colgajo es el de Santos, en 1980. 5 Puede ser elevado aislado o combinado con los otros colgajos provenientes del tronco arterial toracodorsal.…”

Section: Introductionunclassified

“…5 Puede ser elevado aislado o combinado con los otros colgajos provenientes del tronco arterial toracodorsal. 1 Permite el cierre primario del área donante, con un resultado estético aceptable y mínima morbilidad. Se lo ha utilizado en una gran variedad de procedimientos reconstructivos, principalmente en defectos de cobertura en cabeza y cuello.…”

Section: Introductionunclassified

Colgajo paraescapular en pérdidas postraumáticas de tejidos blandos de las extremidades. [Parascapular flap in post-traumatic soft-tissue loss at the limbs.]

Vanoli

Murillo

Centeno

et al. 2018

Rev. Asoc. Arg. Ort. y Traumatol

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ResumenIntroducción: El objetivo de este artículo es comunicar los resultados obtenidos con el uso del colgajo paraescapular para cubrir defectos severos postraumáticos de tejidos blandos en las extremidades. Materiales y Métodos: Estudio retrospectivo, descriptivo, de una serie de 20 pacientes a los que se les realizó un colgajo libre paraescapular para cubrir lesiones masivas combinadas postraumáticas de tejidos blandos en las extremidades, entre 2006 y 2017. La edad de los pacientes promedió 30 años (18 hombres, 2 mujeres). La localización de las lesiones fue: 10 en antebrazo y muñeca, una en la región inguinal, siete en la pierna y dos en tobillo/pie. Resultados: El seguimiento promedio fue de 3.6 años. Se logró la cobertura exitosa en 17 casos. El tamaño de los colgajos promedió 24,8 x 10,7 cm. Seis casos presentaron lesiones vasculonerviosas que necesitaron injerto, seis se asociaron a pérdidas óseas, 11 requirieron injerto de piel y cuatro, reconstrucciones tendinosas. En todos los pacientes, el área donante cerró en forma primaria y sin secuelas funcionales. Dicho colgajo se combinó con el escapular en tres casos y con colgajo de dorsal ancho en tres casos. Dos colgajos fallaron y debió amputarse la extremidad lesionada; un paciente falleció por embolia masiva al séptimo día de la cirugía. Conclusiones: El colgajo paraescapular permitió salvar y reconstruir satisfactoriamente defectos masivos extensos en 17 de 20 extremidades, sin morbilidad para la zona donante del colgajo, pero su uso no está exento de complicaciones, y un abordaje multidisciplinario es necesario para disminuir esta morbilidad. The aim of this paper is to present the results after the use of parascapular free flaps to cover severe softtissue defects at the extremities. Methods: A retrospective, descriptive study of 20 patients who received parascapular free flaps to cover massive combined soft-tissue lesions at the extremities as a salvage procedure from 2006 to 2017 was performed. Patients' age averaged 30 years (18 men, 2 women). Sites of lesions were: ten at the forearm and wrist, one at the inguinal region, seven at the leg and two at the ankle/foot. Results: Follow-up averaged 3.6 years. Successful coverage was achieved in 17 cases. Flap size averaged 24.8 x 10.7 cm. There were six cases with neurovascular lesions that needed grafting, six cases had associated bone loss, eleven patients needed skin graft and four required tendon reconstructions. Donor area closed primarily without functional limitations in all patients. In three cases the flap was combined with a scapular flap and in three cases with a latissimus dorsi flap. Two flaps failed and the injured limb was amputated; one patient died due to massive embolism seven days after surgery. Conclusions: Parascapular free flaps allowed salvage and reconstruction of 17 out of 20 severely injured limbs, without morbidity for the donor area. But its use is not free of complications, and a multidisciplinary approach is necessary to reduce this morbidity.

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Primary versus Delayed Soft Tissue Coverage for Severe Open Tibial Fractures

Cited by 219 publications

References 0 publications

Management and outcome in patients with below knee soft tissue injuries

Management and outcome in patients with below knee soft tissue injuries

Outcome of application of primary versus secondary Illizarov's fixator in open tibial shaft fractures

Colgajo paraescapular en pérdidas postraumáticas de tejidos blandos de las extremidades. [Parascapular flap in post-traumatic soft-tissue loss at the limbs.]

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