Background:
The goal of lower extremity reconstruction is to cover defects and open wounds of the leg, ensuring patients achieve a healed wound and can resume their lives and return to work while avoiding amputation. Orthopedic and plastic surgeons often encounter complex lower extremity wounds, which are challenging due to potential complications involving bones, soft tissues, or medical equipment. Firstly, this study seeks to confirm or challenge the principle of simultaneous coverage and definitive fixation. Secondly, it aims to quantify the potential consequences of late coverage, not only on bone union and deep bone infection but also on the number of procedures, and the length of hospital stay
Materials and Methods:
This study was designed as a monocentric retrospective study at Lausanne University Hospital, based on a prospectively maintained database including all lower limb flaps for open fractures. All adults (>18 years old) patients who presented with a traumatic open fracture of the lower limb and who benefited from a flap-based coverage surgical procedure (either pedicled flap or free flap) between January 2019 and April 2022 were included. Patients were followed from the time of initial presentation until complete healing of soft tissues and bones (radiological and clinical bone union). Population's characteristics, intervention details, and occurrence of complications were collected from the hospital electronic medical records (Soarian® and Archimede®). Patients who refused to participate, to sign the general consent form for the use of clinical data, those who signed it but for whom we could not find digital, or paper evidence were excluded. Continuous variables are presented as mean while discrete data are presented as full numbers or percentage. Differences in characteristics and outcomes were assessed using two‐sided exact Fisher's test for categorical variables and Student test for continuous variables. All analyses were performed using R Studio.
Results:
The study population consisted of 16 patients We observed the occurrence of osteomyelitis in 1 out of 12 patients (8.3%) in the group with flap fixation within 7 days, compared to 4 out of 4 patients (100%) in the group with flap fixation after 7 days (p-value = 0.042) Additionally, the average time to bone union was significantly shorter in the group with flap fixation within 7 days, with a mean of 9.3 months, compared to 25.3 months in the group with flap fixation after 7 days (p-value = 0.018). Interestingly, the total number of procedures and the total length of hospitalization after the final coverage were equal in both groups, showing no significant difference.
Conclusions :
Patients undergoing flap procedures less than 7 days after definitive fixation for Gustilo 3b and 3c fractures experienced a significant decrease in the percentage of osteomyelitis and time to bone union. Minimizing the delay between definitive fixation and flap coverage has the potential to further reduce the incidence of osteomyelitis and shorten the time to bone union. This highlights the importance of a collaborative orthoplastic reconstruction approach.