Resumen
Background: Soft-tissue complications often dictate the success of limb salvage and the overall outcome of open fractures. Based on prior work at the R Adams Cowley Shock Trauma Center, the authors hypothesize that wounds larger than 200 cm2 are associated with a greater likelihood of both flap-related reoperation and wound complications among patients requiring soft-tissue reconstruction with a rotational flap or free tissue transfer. Methods: This study was a secondary analysis of Fluid Lavage in Open Wounds trial data that included all patients who received a rotational or free tissue flap transfer for an open fracture. The primary outcome was flap-related reoperation within 12 months of injury. The secondary outcome was wound complication, which included events treated operatively or nonoperatively. Multivariable logistic regression was used to assess the association between wound size and outcomes, adjusting for confounders. Results: Seventeen percent of the 112 patients required a flap-related reoperation. A wound size greater than 200 cm2 was not associated with reoperation in an unadjusted model (p = 0.64) or adjusting for Gustilo type (p = 0.70). The sample had an overall wound complication rate of 47.3 percent. Patients with a wound size of greater than 200 cm2 were three times more likely to experience wound complications (OR, 3.05; 95 percent CI, 1.08 to 8.62; p = 0.04) when adjusting for moderate to severe wound contamination and wound closure in the operating room. Conclusion: The findings of this study demonstrate that wound surface area is an integral determinant for wound complication following soft-tissue flap treatment, but found no association between wound surface area and flap-related reoperation rates.
| Idioma original | English |
|---|---|
| Páginas (desde-hasta) | 228-236 |
| Número de páginas | 9 |
| Publicación | Plastic and Reconstructive Surgery |
| Volumen | 142 |
| N.º | 1 |
| DOI | |
| Estado | Published - 2018 |
| Publicado de forma externa | Sí |
Nota bibliográfica
Funding Information:The study was funded by the Canadian Institutes of Health Research (MCT-93173), the U.S. Army Institute of Surgical Research Orthopedic Trauma Research Program (W81XWH-08-1-0473), the U.S. Army Institute of Surgical Research Peer Reviewed Orthopedic Research Program (W81XWH-12-1-0530), and the Association Internationale pour l’Ostéosynthèse Dynamique.
Funding Information:
Disclosure: Dr. Bhandari reports receiving consulting fees from Stryker, Smith & Nephew, Amgen, Eli Lilly, DJO Global, Zimmer, and Ferring Pharmaceuticals, and grant support from Stryker, Amgen, DePuy Synthes, Eli Lilly, and DJO Global. Dr. Jeray receives consulting fees from Zimmer and Eli Lilly and lecture fees from Zimmer and AO North America. Dr. Petri-sor reports consulting fees from Stryker and Pfizer, and research support from Stryker and Zimmer. Dr. Sprague is an employee of Global Research Solutions. Dr. Pensy reports consulting fees from Globus Medical. Dr. Slobogean reports being a paid presenter for Zimmer Biomet. No other potential conflict of interest relevant to this article was reported.
Publisher Copyright:
Copyright © 2018 by the American Society of Plastic Surgeons.
ASJC Scopus Subject Areas
- Surgery
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En: Plastic and Reconstructive Surgery, Vol. 142, N.º 1, 2018, p. 228-236.
Producción científica: Contribución a una revista › Artículo › revisión exhaustiva
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TY - JOUR
T1 - Wound surface area as a risk factor for flap complications among patients with open fractures
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AU - O'Hara, Nathan N.
AU - Sprague, Sheila A.
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AU - Jeray, Kyle J.
AU - Zhan, Min
AU - Slobogean, Gerard P.
AU - Pensy, Raymond A.
AU - Guyatt, Gordon H.
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AU - Schemitsch, Emil H.
AU - Tornetta, Paul
AU - Anglen, Jeff
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AU - Ahn, Henry
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AU - Kandemir, Utku
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AU - Halvorsen, Vera
AU - Hjorthaug, Geir
AU - Lippert, Anders
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AU - Molund, Marius
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AU - Rydinge, Jonas
AU - Hemlock, Kim
AU - Brattgjerd, Jan Egil
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AU - Rai, Anil K.
AU - Rai, Kamal Narayan
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AU - Karne, Narayan J.
AU - Metha, Chetan
AU - Shankar, A. Navaladi
AU - Navaladi Shankar, A.
AU - Saravana, R.
AU - Gupta, Ajay
AU - Jain, Neeraj
AU - Bhatia, Mahesh
AU - Arora, Vinod
AU - Tyagi, Vivek
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N1 - Funding Information: The study was funded by the Canadian Institutes of Health Research (MCT-93173), the U.S. Army Institute of Surgical Research Orthopedic Trauma Research Program (W81XWH-08-1-0473), the U.S. Army Institute of Surgical Research Peer Reviewed Orthopedic Research Program (W81XWH-12-1-0530), and the Association Internationale pour l’Ostéosynthèse Dynamique. Funding Information: Disclosure: Dr. Bhandari reports receiving consulting fees from Stryker, Smith & Nephew, Amgen, Eli Lilly, DJO Global, Zimmer, and Ferring Pharmaceuticals, and grant support from Stryker, Amgen, DePuy Synthes, Eli Lilly, and DJO Global. Dr. Jeray receives consulting fees from Zimmer and Eli Lilly and lecture fees from Zimmer and AO North America. Dr. Petri-sor reports consulting fees from Stryker and Pfizer, and research support from Stryker and Zimmer. Dr. Sprague is an employee of Global Research Solutions. Dr. Pensy reports consulting fees from Globus Medical. Dr. Slobogean reports being a paid presenter for Zimmer Biomet. No other potential conflict of interest relevant to this article was reported. Publisher Copyright: Copyright © 2018 by the American Society of Plastic Surgeons.
PY - 2018
Y1 - 2018
N2 - Background: Soft-tissue complications often dictate the success of limb salvage and the overall outcome of open fractures. Based on prior work at the R Adams Cowley Shock Trauma Center, the authors hypothesize that wounds larger than 200 cm2 are associated with a greater likelihood of both flap-related reoperation and wound complications among patients requiring soft-tissue reconstruction with a rotational flap or free tissue transfer. Methods: This study was a secondary analysis of Fluid Lavage in Open Wounds trial data that included all patients who received a rotational or free tissue flap transfer for an open fracture. The primary outcome was flap-related reoperation within 12 months of injury. The secondary outcome was wound complication, which included events treated operatively or nonoperatively. Multivariable logistic regression was used to assess the association between wound size and outcomes, adjusting for confounders. Results: Seventeen percent of the 112 patients required a flap-related reoperation. A wound size greater than 200 cm2 was not associated with reoperation in an unadjusted model (p = 0.64) or adjusting for Gustilo type (p = 0.70). The sample had an overall wound complication rate of 47.3 percent. Patients with a wound size of greater than 200 cm2 were three times more likely to experience wound complications (OR, 3.05; 95 percent CI, 1.08 to 8.62; p = 0.04) when adjusting for moderate to severe wound contamination and wound closure in the operating room. Conclusion: The findings of this study demonstrate that wound surface area is an integral determinant for wound complication following soft-tissue flap treatment, but found no association between wound surface area and flap-related reoperation rates.
AB - Background: Soft-tissue complications often dictate the success of limb salvage and the overall outcome of open fractures. Based on prior work at the R Adams Cowley Shock Trauma Center, the authors hypothesize that wounds larger than 200 cm2 are associated with a greater likelihood of both flap-related reoperation and wound complications among patients requiring soft-tissue reconstruction with a rotational flap or free tissue transfer. Methods: This study was a secondary analysis of Fluid Lavage in Open Wounds trial data that included all patients who received a rotational or free tissue flap transfer for an open fracture. The primary outcome was flap-related reoperation within 12 months of injury. The secondary outcome was wound complication, which included events treated operatively or nonoperatively. Multivariable logistic regression was used to assess the association between wound size and outcomes, adjusting for confounders. Results: Seventeen percent of the 112 patients required a flap-related reoperation. A wound size greater than 200 cm2 was not associated with reoperation in an unadjusted model (p = 0.64) or adjusting for Gustilo type (p = 0.70). The sample had an overall wound complication rate of 47.3 percent. Patients with a wound size of greater than 200 cm2 were three times more likely to experience wound complications (OR, 3.05; 95 percent CI, 1.08 to 8.62; p = 0.04) when adjusting for moderate to severe wound contamination and wound closure in the operating room. Conclusion: The findings of this study demonstrate that wound surface area is an integral determinant for wound complication following soft-tissue flap treatment, but found no association between wound surface area and flap-related reoperation rates.
UR - http://www.scopus.com/inward/record.url?scp=85056942077&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85056942077&partnerID=8YFLogxK
U2 - 10.1097/PRS.0000000000004418
DO - 10.1097/PRS.0000000000004418
M3 - Article
C2 - 29608532
AN - SCOPUS:85056942077
SN - 0032-1052
VL - 142
SP - 228
EP - 236
JO - Plastic and Reconstructive Surgery
JF - Plastic and Reconstructive Surgery
IS - 1
ER -