Timing of Free Flaps for Traumatic Wounds of the Lower Extremity: Have Advances in Perioperative Care Changed the Treatment Algorithm?

摘要: Background Despite the landmark study by Godina 30 years ago, opinions still vary within literature about management of complex traumatic wounds in lower extremity. We present a large series extremity reconstructions with vascularized free tissue and examine perioperative factors that influenced success these cases. Methods We reviewed 88 patients flap reconstruction over 8 years. Primary outcomes were infections, loss, total flap-specific complications, recipient site complications. Independent variables specific to care including time coverage, injury classification, exposed or infected hardware, prior osteomyelitis, use wound vacuum-assisted closure (VAC) therapy, concurrent polytrauma investigated establish their influence on primary outcomes. Each independent variable was assessed using Chi-square Fisher's exact test included logistic regression analysis significance. Results Of patients, had 23 adverse Timing reconstruction, VAC use, hardware status, presence no statistically significant impact Injury classification/severity complications (p = 0.051) (p = 0.073) trended toward significance; however, subgroup did not achieve Logistic any complication all similarly showed Conclusion Although original suggests early coverage is critical optimize outcomes, modern era advanced care, our adds growing body evidence supports de-emphasis 72-hour interval. Our current focused more effectively coordinating efficient peritraumatic an individualized basis often very complicated patient.