A review of forty five open tibial fractures covered with free flaps. Analysis of complications, microbiology and prognostic factors
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A review of forty five open tibial fractures covered with free flaps. Analysis of complications, microbiology and prognostic factors. / Olesen, Ulrik Kähler; Juul, Rasmus; Bonde, Christian Torsten; Moser, Claus Ernst; McNally, Martin; Jensen, Lisa Toft; Elberg, Jens Jørgen; Eckardt, Henrik.
In: International Orthopaedics, Vol. 39, No. 6, 06.2015, p. 1159-66.Research output: Contribution to journal › Journal article › Research › peer-review
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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
Y1 - 2015/6
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
VL - 39
SP - 1159
EP - 1166
JO - International Orthopaedics
JF - International Orthopaedics
SN - 0341-2695
IS - 6
ER -
ID: 161730729