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Evaluation of Timing in Definitive Soft Tissue Coverage
Dylan Childs, Meridith Ginesi, Douglas Wagner
Summa Health Systems
2018-02-14
Presenter: Dylan Childs
Affidavit:
The residents was conceived accrued and analyzed by the house staff
Director Name: Douglas Wagner
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Purpose: Soft tissue coverage for traumatic grade III tibial fractures has been studied and the field has been advanced by the works of Godina. Coordinated studies such as the Lower Extremity Assessment Project (LEAP) then shed light on factors influencing post-operative complications in lower extremity trauma. The aim of this study was to evaluate timing of definitive coverage and subsequent infection requiring hardware removal in our trauma population.
Methods: A retrospective chart review of a trauma database from 2008-2015 was performed to identify patients with Grade III tibial fractures requiring flap coverage. Follow-up, revision surgery, negative pressure wound therapy, timing of initial & subsequent washouts, timing of definitive soft tissue coverage & hardware removal for infection were analyzed.
Results: 41 total patients required soft tissue coverage. Group 1 did not require reoperation and Group 2 required reoperation. All patients received initial debridement within 24 hours. 51% (n=21) required reoperation for hardware removal after definitive soft tissue coverage. There was statistical difference between length to flap coverage in Group 1 and Group 2 (p=0.0411)
Conclusions: While some studies have shown no difference between achieving definitive soft tissue coverage in relation to timing and others have shown that the subacute period described by Godina can be extended, our results indicate that the need for reoperation and hardware removal can be improved with earlier definitive soft tissue coverage.
