Local flaps vs. free flaps for complex lower limb fractures: Effect of flap choice on patient-reported outcomes.

Autor: Bhullar DS; Dept of Trauma and Orthopaedic Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, UK., Karuppiah SV; Dept of Trauma and Orthopaedic Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, UK., Aljawadi A; Dept of Trauma and Orthopaedic Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, UK., Gillham T; Dept of Trauma and Orthopaedic Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, UK., Fakih O; Dept of Trauma and Orthopaedic Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, UK., Khamdan K; Dept of Trauma and Orthopaedic Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, UK., Pillai A; Dept of Trauma and Orthopaedic Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, UK.
Jazyk: angličtina
Zdroj: Journal of orthopaedics [J Orthop] 2019 Nov 12; Vol. 17, pp. 91-96. Date of Electronic Publication: 2019 Nov 12 (Print Publication: 2020).
DOI: 10.1016/j.jor.2019.11.016
Abstrakt: The optimal flap cover for managing open lower limb fractures is debated. Most studies have reported on surgical outcome but clinical outcome is not well recognised. We aimed to determine whether there are differences in patient-reported quality of life (QoL) outcome between local flap versus free flap. All patients admitted with lower limb open fractures were retrospectively reviewed. Patient notes were assessed for demographics, time to fracture union, wound healing and patient-reported QoL with EQ-5D-5L alongside a novel flap assessment tool. A total of 40 patients had flap reconstruction of their lower limb injury; 23 local flap (Group I) and 17 free flap (Group II). Average length of follow-up was 33.8 months. Group I - 10 revisions of flaps (43.5%) and 14 surgical complications (60.9%). Fracture union was 171 days and wound healing 130 days. EQ-5D index and EQ-VAS scores were 0.709 and 79.3, respectively. Group II - 8 revision of flaps (47.1%) and 12 surgical complications (70.6%). Fracture union was 273 days and wound healing 213 days. EQ-5D index and EQ-VAS scores were 0.525 and 57.2, respectively. Aesthetic appeal - 48% Group I vs. 66% Group II. Significant differences were found between the two flap groups with higher scores for daily living in Group I (p = 0.007) compared to higher overall flap ratings in Group II (p = 0.049). Both groups were comparable in terms of complications; while flap congestion and dehiscence were more common with free flaps statistical interrogation did not elicit significance (p > 0.05). Local flap and free flap techniques offer distinct advantages. Local flaps have better surgical outcome and patient-reported QoL in the first few years post soft tissue reconstruction. Differences between local and free reconstructive techniques in terms of patient health and function are ameliorated in the longer term.
Competing Interests: The authors have no conflicts of interest to declare with respect to the submitted manuscript.
(© 2019 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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