The Continued Impact of Godina's Principles: Outcomes of Flap Coverage as a Function of Time After Definitive Fixation of Open Lower Extremity Fractures.

IF 2.2 3区 医学 Q2 SURGERY Journal of reconstructive microsurgery Pub Date : 2024-10-01 Epub Date: 2024-02-21 DOI:10.1055/a-2273-4075
Elliot L H Le, Colin T McNamara, Ryan S Constantine, Mark A Greyson, Matthew L Iorio
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Abstract

Background:  Early soft tissue coverage of open lower extremity fractures within 72 hours of injury leads to improved outcomes. Little is known about outcomes when definitive fixation is completed first. The purpose of this study is to quantify postoperative outcomes when soft tissue reconstruction is delayed until after definitive open reduction and internal fixation (ORIF) is completed.

Methods:  An insurance claims database was queried for all patients with open lower extremity fractures between 2010 and 2020 who underwent free or axial flap reconstruction after ORIF. This cohort was stratified into three groups: reconstruction performed 0 to 3, 3 to 7, and 7+ days after ORIF. The primary outcome was 90-day complication and reoperation rates. Bivariate and multivariable regression of all-cause complications and reoperations was evaluated for time to flap as a risk factor.

Results:  A total of 863 patients with open lower extremity fractures underwent ORIF prior to flap soft tissue reconstruction. In total, 145 (16.8%), 162 (18.8%), and 556 (64.4%) patients underwent soft tissue reconstruction 0 to 3 days, 4 to 7 days, and 7+ days after ORIF, respectively. The 90-day complication rate of surgical site infections ( SSI; 16.6%, 16,7%, 28.8%; p = 0.001) and acute osteomyelitis (5.5%, 6.2%, 27.7%; p < 0.001) increased with delayed soft tissue reconstruction. Irrigation and debridement rates were directly related to time from ORIF to flap (33.8%, 51.9%, 61.9%; p < 0.001). Hardware removal rates were significantly higher with delayed treatment (10.3%, 9.3%, 39.3%; p < 0.001). The 0 to 3 day (odds ratio [OR] = 0.22; 95% confidence interval [CI]: 0.15, 0.32) and 4 to 7 day (OR = 0.26; 95% CI: 0.17, 0.40) groups showed protective factors against all-cause complications after bivariate and multivariate regression.

Conclusion:  Early soft tissue reconstruction of open lower extremity fractures performed within 7 days of ORIF reduces complication rates and reduces the variability of complication rates including SSIs, acute osteomyelitis, and hardware failure.

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戈迪纳原则的持续影响:开放性下肢骨折确定性固定术后皮瓣覆盖时间的影响。
目的:在受伤 72 小时内对开放性下肢骨折进行早期软组织覆盖可改善预后。而对于先完成最终固定的疗效却知之甚少。本研究旨在量化软组织重建延迟到开放复位内固定术(ORIF)完成后的术后效果:方法:在保险理赔数据库中查询了 2010 年至 2020 年间所有开放性下肢骨折患者,这些患者在 ORIF 后接受了游离或轴向皮瓣重建术。该群体被分为三组:手术后 0-3 天、3-7 天和 7 天以上进行重建的患者。主要结果是90天并发症和再次手术率。对全因并发症和再手术的双变量和多变量回归进行了评估,将翻瓣时间作为一个风险因素:共有863名开放性下肢骨折患者在皮瓣软组织重建前接受了ORIF手术。分别有145例(16.8%)、162例(18.8%)和556例(64.4%)患者在ORIF术后0-3天、4-7天和7天以上接受了软组织重建。手术部位感染(16.6%、16.7%、28.8%;P = 0.001)和急性骨髓炎(5.5%、6.2%、27.7%;P < 0.001)的 90 天并发症发生率随软组织重建的延迟而增加。冲洗和清创率与从 ORIF 到皮瓣的时间直接相关(33.8%、51.9%、61.9%;P < 0.001)。延迟治疗的硬件移除率明显更高(10.3%、9.3%、39.3%;P < 0.001)。经二变量和多变量回归后,0-3 天组(OR = 0.22;95% CI:0.15, 0.32)和 4-7 天组(OR = 0.26;95% CI:0.17, 0.40)对全因并发症具有保护作用:结论:开放性下肢骨折术后七天内进行早期软组织重建可降低并发症发生率,并减少手术部位感染、急性骨髓炎和硬件故障等并发症发生率的变化。
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来源期刊
CiteScore
4.50
自引率
28.60%
发文量
80
审稿时长
1 months
期刊介绍: The Journal of Reconstructive Microsurgery is a peer-reviewed, indexed journal that provides an international forum for the publication of articles focusing on reconstructive microsurgery and complex reconstructive surgery. The journal was originally established in 1984 for the microsurgical community to publish and share academic papers. The Journal of Reconstructive Microsurgery provides the latest in original research spanning basic laboratory, translational, and clinical investigations. Review papers cover current topics in complex reconstruction and microsurgery. In addition, special sections discuss new technologies, innovations, materials, and significant problem cases. The journal welcomes controversial topics, editorial comments, book reviews, and letters to the Editor, in order to complete the balanced spectrum of information available in the Journal of Reconstructive Microsurgery. All articles undergo stringent peer review by international experts in the specialty.
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