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

TY - JOUR

T1 - A review of forty five open tibial fractures covered with free flaps. Analysis of complications, microbiology and prognostic factors

AU - Olesen, Ulrik Kähler

AU - Juul, Rasmus

AU - Bonde, Christian Torsten

AU - Moser, Claus Ernst

AU - McNally, Martin

AU - Jensen, Lisa Toft

AU - Elberg, Jens Jørgen

AU - Eckardt, Henrik

PY - 2015/6/8

Y1 - 2015/6/8

N2 - Purpose: 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. Methods: 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. Results: 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 bacteria found were often resistant to Cefuroxime, aminoglycosides or amoxicillin, but sensitive to vancomycin or meropenem. Conclusion: Flap cover within one week is essential to avoid infection. High-energy trauma and smoking are important predictors of complications. We suggest antibiotic prophylaxis with vancomycin and meropenem until the wound is covered in these complex injuries.

AB - Purpose: 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. Methods: 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. Results: 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 bacteria found were often resistant to Cefuroxime, aminoglycosides or amoxicillin, but sensitive to vancomycin or meropenem. Conclusion: Flap cover within one week is essential to avoid infection. High-energy trauma and smoking are important predictors of complications. We suggest antibiotic prophylaxis with vancomycin and meropenem until the wound is covered in these complex injuries.

KW - Adult

KW - Aged

KW - Amputation

KW - Antibiotic Prophylaxis

KW - Female

KW - Fractures, Open

KW - Free Tissue Flaps

KW - Humans

KW - Male

KW - Middle Aged

KW - Postoperative Complications

KW - Prognosis

KW - Retrospective Studies

KW - Smoking

KW - Surgical Wound Infection

KW - Tibial Fractures

KW - Treatment Outcome

KW - Wound Healing

U2 - 10.1007/s00264-015-2712-z

DO - 10.1007/s00264-015-2712-z

M3 - Journal article

C2 - 25750130

SN - 0341-2695

VL - 39

SP - 1159

EP - 1166

JO - International Orthopaedics

JF - International Orthopaedics

IS - 6

ER -