Delayed reconstruction of mangled lower extremities: soft tissue management

Yiğit Özer Tiftikcioğlu; Burak Sercan Erçin; Mehmet Erdem; Ahmet Biçer; Nadir Özkayın; Cüneyt Özek

doi:10.5606/fng.btd.2017.005

Yiğit Özer Tiftikcioğlu¹, Burak Sercan Erçin¹, Mehmet Erdem¹, Ahmet Biçer¹, Nadir Özkayın², Cüneyt Özek¹

¹Ege Üniversitesi Tıp Fakültesi Plastik, Rekonstrüktif ve Estetik Cerrahi Anabilim Dalı, İzmir, Turkey
²Ege Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, İzmir, Turkey

Keywords: Debridement; lower limb; microsurgery; soft-tissue reconstruction; vacuum assisted closure.

Abstract

Objectives: This study aims to propose a new, practical and versatile algorithm for the management of traumatic lower limb soft tissue wounds for patients who did not undergo early reconstruction.

Materials and methods: A total of 81 patients (54 males, 27 females; mean age 37.1 years; range 11 to 64 years) managed due to complex lower limb injuries at our institution between January 2008 and December 2012 were analyzed retrospectively in this study. Age and gender of the patients, type of trauma, utilization of vacuum assisted closure (VAC) therapy, time lapse between injury and definitive reconstruction, as well as major and minor complications were recorded and analyzed.

Results: The average time from injury to definitive reconstruction procedure was 20.4 days. Sixty two percent of the patients were treated with VAC therapy before the definitive reconstruction. Hospital stay ranged from 5 to 100 days, with a mean stay of 42.7 days. Thirteen and a half percent of patients had a soft-tissue defect in the proximal one third, 33.3% in the middle one third and 53.2% in the distal one third of the leg. Overall, the rate of complications was 12.3%.

Conclusion: Based on the findings of this study, we believe that post-traumatic lower extremity reconstruction may safely be performed when the wound is adequately debrided and when the surgeon follows the basic principles of reconstructive surgery even in a sub-acute or delayed fashion. We also proposed a clinical algorithm regarding the reconstructive options.