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

Abstract

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.

Shish kebab technique used to treat severe trauma to the foot: a case report

“…She received standard care as per the British Association of Plastic, Reconstructive and Aesthetic Surgeons' (BAPRAS) guidelines. 5 The trauma and orthopaedic surgeon on call washed out the wound and treated the fracture with a mini external fixator device (Figure 2). The wound was left to granulate, and the initial plan was to get a vascularized iliac crest graft inserted by a plastic surgeon.…”

“…This was classified as Gustillo and Anderson type 3A. She received standard care as per the British Association of Plastic, Reconstructive and Aesthetic Surgeons’ (BAPRAS) guidelines 5…”

“…The goal in managing all fractures with bone loss is solid bone union, acceptable alignment, equal limb length and restoration of function. Several techniques are described to treat bone loss including, but not limited to, vascularized free fibular graft, distraction osteogenesis and the Masquelet technique 5…”

“…Several techniques are described to treat bone loss including, but not limited to, vascularized free fibular graft, distraction osteogenesis and the Masquelet technique. 5 The purpose of this case report was to highlight the challenges faced by the surgeon in the setting of traumatic bone loss. The authors want to emphasize the importance of detailed preoperative planning to ensure an optimal outcome for the patient.…”

Reconstruction Options for Lower Extremity Traumatic Wounds

“…1 Early treatment of a patient sustaining severe lower extremity trauma at a specialized orthoplastic limb salvage center should be the standard of care, and the lower extremity guidelines for salvage should be widely embraced to expedite referrals. [2][3][4] The goals of limb salvage are to optimize limb appearance, restore unrestricted pain-free ambulation, and improve quality of life. Our algorithm for the management of composite defects of the lower extremity below the knee has been previously described (Figure 1).…”