Improving Reemployment Rates after Limb Salvage of Acute Severe Tibial Fractures by Microvascular Soft-Tissue Reconstruction

1994 ◽  
Vol 93 ◽  
pp. 1028-1034 ◽  
Author(s):  
Thomas J. Francel
Keyword(s):  
Soft Tissue ◽  
Limb Salvage ◽  
Tibial Fractures ◽  
Soft Tissue Reconstruction ◽  
Tissue Reconstruction

Outcomes of Soft Tissue Reconstruction for Traumatic Lower Extremity Fractures with Compromised Vascularity

2017 ◽  
Vol 83 (10) ◽  
pp. 1161-1165 ◽  
Author(s):  
Ido Badash ◽  
Karen E. Burtt ◽  
Hyuma A. Leland ◽  
Daniel J. Gould ◽  
Alexis D. Rounds ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Limb Salvage ◽  
Arterial Injury ◽  
Soft Tissue Reconstruction ◽  
Complication Rates ◽  
Arterial Injuries ◽  
Flap Failure ◽  
Vascular Compromise ◽  
Tissue Reconstruction

Traumatic lower extremity fractures with compromised arterial flow are limb-threatening injuries. A retrospective review of 158 lower extremities with traumatic fractures, including 26 extremities with arterial injuries, was performed to determine the effects of vascular compromise on flap survival, successful limb salvage and complication rates. Patients with arterial injuries had a larger average flap surface area (255.1 vs 144.6 cm2, P = 0.02) and a greater number of operations (4.7 vs 3.8, P = 0.01) than patients without vascular compromise. Patients presenting with vascular injury were also more likely to require fasciotomy [odds ratio (OR): 6.5, confidence interval (CI): 2.3–18.2] and to have a nerve deficit (OR: 16.6, CI: 3.9–70.0), fracture of the distal third of the leg (OR: 2.9, CI: 1.15–7.1) and intracranial hemorrhage (OR: 3.84, CI: 1.1–12.9). After soft tissue reconstruction, patients with arterial injuries had a higher rate of amputation (OR: 8.5, CI: 1.3–53.6) and flap failure requiring a return to the operating room (OR: 4.5, CI: 1.5–13.2). Arterial injury did not correlate with infection or overall complication rate. In conclusion, arterial injuries resulted in significant complications for patients with lower extremity fractures requiring flap coverage, although limb salvage was still effective in most cases.

The Lymphatic Response to Injury with Soft-Tissue Reconstruction in High-Energy Open Tibial Fractures of the Lower Extremity

2017 ◽  
Vol 139 (2) ◽  
pp. 483-491 ◽  
Author(s):  
Malou C. van Zanten ◽  
Raakhi M. Mistry ◽  
Hiroo Suami ◽  
Andrew Campbell-Lloyd ◽  
James P. Finkemeyer ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
High Energy ◽  
Tibial Fractures ◽  
Soft Tissue Reconstruction ◽  
Open Tibial Fractures ◽  
Tissue Reconstruction

Patient and Surgical Factors Contributing to Perioperative Infection in Complex Lower Extremity Trauma

2016 ◽  
Vol 82 (10) ◽  
pp. 940-943 ◽  
Author(s):  
Karen E. Burtt ◽  
Alexis D. Rounds ◽  
Hyuma A. Leland ◽  
Ram K. Alluri ◽  
Ketan M. Patel ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Limb Salvage ◽  
Perioperative Outcomes ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Infection Rates ◽  
Lower Extremity Injuries ◽  
Tissue Reconstruction ◽  
Extremity Injuries

Infections in the traumatized lower extremity are a significant source of morbidity and expense. Outcomes after vascularized soft tissue reconstruction were analyzed to determine impact on infection rates. A retrospective review of a prospectively maintained database was performed, including 114 trauma patients requiring soft tissue reconstruction of lower extremity injuries at an urban Level I tertiary referral center from 2008 to 2015. Patient characteristics and perioperative outcomes were analyzed. After trauma, 39 (34.2%) patients developed wound infections, of which 74.4 per cent of infections occurred before soft tissue coverage. Isolated lower extremity injury yielded a 4-fold increase in the incidence of infection. Infection rates doubled in patients who smoked, sustained a fall, had a proximal third of the lower leg wound, or underwent external fixation. Comorbid diabetes, underlying fracture, and wound size were not predictive of infection. Overall, there was a 97.4 per cent rate of limb salvage after soft tissue reconstruction. In patients with infection before soft tissue reconstruction, a salvage rate of 96.6 per cent was achieved. Soft tissue reconstruction in the traumatized and infected lower extremity resulted in high limb salvage success rates, demonstrating vascularized tissue transfer in lower extremity injuries is effective in treating lower extremity infection.

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