A review of forty five open tibial fractures covered with free flaps. Analysis of complications, microbiology and prognostic factors

International Orthopaedics
Ulrik Kähler OlesenHenrik Eckardt

Abstract

Treatment of open fractures is complex and controversial. The purpose of the present study is to add evidence to the management of open tibial fractures, where tissue loss necessitates cover with a free flap. We identified factors that increase the risk of complications. We questioned whether early flap coverage improved the clinical outcome and whether we could improve our antibiotic treatment of open fractures. From 2002 to 2013 we treated 56 patients with an open tibial fracture covered with a free flap. We reviewed patient records and databases for type of trauma, smoking, time to tissue cover, infection, amputations, flap loss and union of fracture. We identified factors that increase the risk of complications. We analysed the organisms cultured from open fractures to propose the optimal antibiotic prophylaxis. Follow-up was a minimum of one year. Primary outcome was infection, bacterial sensitivity pattern, amputation, flap failure and union of the fracture. When soft tissue cover was delayed beyond seven days, infection rate increased from 27 to 60 % (p < 0.04). High-energy trauma patients had a higher risk of amputation, infection, flap failure and non-union. Smokers had a higher risk of non-union and flap failure. The ...Continue Reading

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Citations

May 6, 2016·The New England Journal of Medicine·Mohit BhandariKyle J Jeray
Aug 24, 2017·International Orthopaedics·Willem-Jan MetsemakersStefaan Nijs
Feb 2, 2017·World Journal of Orthopedics·Barakat Sayed El-Alfy
Jul 25, 2019·Plastic and Reconstructive Surgery·Z-Hye LeeJamie P Levine
Oct 9, 2019·Journal of the American Academy of Orthopaedic Surgeons. Global Research & Reviews·Ulrik Kähler OlesenJohn E Herzenberg
Mar 15, 2018·International Orthopaedics·Raquel Bernardelli IamaguchiRames Mattar
Aug 29, 2019·Plastic and Reconstructive Surgery·Z-Hye LeeJamie P Levine
Sep 19, 2020·International Orthopaedics·Daniel Pérez-PrietoJuan Carlos Monllau
Aug 30, 2019·Journal of Orthopaedic Trauma·Willem-Jan MetsemakersUNKNOWN Fracture-Related Infection (FRI) consensus group
Nov 16, 2016·International Orthopaedics·Ulrik Kähler OlesenMartin McNally
May 6, 2016·The New England Journal of Medicine·Olivier Barbier, Pierre Pasquier
Aug 26, 2019·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·M DepypereW-J Metsemakers

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