Early soft tissue coverage and negative pressure wound therapy optimises patient outcomes in lower limb trauma
Liu DSH et al. – Following open lower limb trauma, soft tissue coverage within 3days of injury and immediately following fracture fixation with exposed metalware minimises pre–flap wound infection and optimises surgical outcomes. Negative pressure wound therapy (NPWT) provides effective temporary wound coverage, but does not allow a delay in definitive free–flap reconstruction.Methods
- Retrospective review of all free-flap reconstructions for lower limb trauma undertaken at a tertiary trauma centre between June 2002 and July 2009.
- 103 patients underwent 105 free-flap reconstructions.
- Compared with patients who were reconstructed within 3days of injury, the cohort with delayed reconstruction beyond 7days had significantly increased rates of pre-flap wound infection, flap re-operation, deep metal infection and osteomyelitis.
- Pre-flap wound infection independently predicted adverse surgical outcomes.
- In the setting of exposed metalware, free-flap transfer beyond one day significantly increased the flap failure rate.
- These patients required more surgical procedures and a longer hospital stay.
- The use of NPWT significantly lowered the rate of flap re-operations and venous thrombosis, but did not allow a delay in reconstruction beyond 7days from injury without a concomitant rise in skeletal and flap complications.