Wound Surface Area as a Risk Factor for Flap Complications among Patients with Open Fractures.

Autor:	Shea P; From the Departments of Orthopaedics and Epidemiology and Public Health, University of Maryland School of Medicine; the Department of Health Research Methods, Evidence and Impact, and the Division of Orthopaedic Surgery, Department of Surgery, McMaster University; and the Department of Orthopedic Surgery, Greenville Health System., O'Hara NN; From the Departments of Orthopaedics and Epidemiology and Public Health, University of Maryland School of Medicine; the Department of Health Research Methods, Evidence and Impact, and the Division of Orthopaedic Surgery, Department of Surgery, McMaster University; and the Department of Orthopedic Surgery, Greenville Health System., Sprague SA; From the Departments of Orthopaedics and Epidemiology and Public Health, University of Maryland School of Medicine; the Department of Health Research Methods, Evidence and Impact, and the Division of Orthopaedic Surgery, Department of Surgery, McMaster University; and the Department of Orthopedic Surgery, Greenville Health System., Bhandari M; From the Departments of Orthopaedics and Epidemiology and Public Health, University of Maryland School of Medicine; the Department of Health Research Methods, Evidence and Impact, and the Division of Orthopaedic Surgery, Department of Surgery, McMaster University; and the Department of Orthopedic Surgery, Greenville Health System., Petrisor BA; From the Departments of Orthopaedics and Epidemiology and Public Health, University of Maryland School of Medicine; the Department of Health Research Methods, Evidence and Impact, and the Division of Orthopaedic Surgery, Department of Surgery, McMaster University; and the Department of Orthopedic Surgery, Greenville Health System., Jeray KJ; From the Departments of Orthopaedics and Epidemiology and Public Health, University of Maryland School of Medicine; the Department of Health Research Methods, Evidence and Impact, and the Division of Orthopaedic Surgery, Department of Surgery, McMaster University; and the Department of Orthopedic Surgery, Greenville Health System., Zhan M; From the Departments of Orthopaedics and Epidemiology and Public Health, University of Maryland School of Medicine; the Department of Health Research Methods, Evidence and Impact, and the Division of Orthopaedic Surgery, Department of Surgery, McMaster University; and the Department of Orthopedic Surgery, Greenville Health System., Slobogean GP; From the Departments of Orthopaedics and Epidemiology and Public Health, University of Maryland School of Medicine; the Department of Health Research Methods, Evidence and Impact, and the Division of Orthopaedic Surgery, Department of Surgery, McMaster University; and the Department of Orthopedic Surgery, Greenville Health System., Pensy RA; From the Departments of Orthopaedics and Epidemiology and Public Health, University of Maryland School of Medicine; the Department of Health Research Methods, Evidence and Impact, and the Division of Orthopaedic Surgery, Department of Surgery, McMaster University; and the Department of Orthopedic Surgery, Greenville Health System.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery [Plast Reconstr Surg] 2018 Jul; Vol. 142 (1), pp. 228-236.
DOI:	10.1097/PRS.0000000000004418
Abstrakt:	Background: Soft-tissue complications often dictate the success of limb salvage and the overall outcome of open fractures. Based on prior work at the R Adams Cowley Shock Trauma Center, the authors hypothesize that wounds larger than 200 cm are associated with a greater likelihood of both flap-related reoperation and wound complications among patients requiring soft-tissue reconstruction with a rotational flap or free tissue transfer. Methods: This study was a secondary analysis of Fluid Lavage in Open Wounds trial data that included all patients who received a rotational or free tissue flap transfer for an open fracture. The primary outcome was flap-related reoperation within 12 months of injury. The secondary outcome was wound complication, which included events treated operatively or nonoperatively. Multivariable logistic regression was used to assess the association between wound size and outcomes, adjusting for confounders. Results: Seventeen percent of the 112 patients required a flap-related reoperation. A wound size greater than 200 cm(2) was not associated with reoperation in an unadjusted model (p = 0.64) or adjusting for Gustilo type (p = 0.70). The sample had an overall wound complication rate of 47.3 percent. Patients with a wound size of greater than 200 cm(2) were three times more likely to experience wound complications (OR, 3.05; 95 percent CI, 1.08 to 8.62; p = 0.04) when adjusting for moderate to severe wound contamination and wound closure in the operating room. Conclusion: The findings of this study demonstrate that wound surface area is an integral determinant for wound complication following soft-tissue flap treatment, but found no association between wound surface area and flap-related reoperation rates. Clinical Question/level of Evidence: Risk, III.
Databáze:	MEDLINE
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