Acute limb shortening or creation of an intentional deformity to aid in soft tissue closure for IIIB/IIIC open tibia fractures
| Autor: | Edward A. Sirlin, Garrett A. Cavanaugh, Randy M. Hauck, J. Spence Reid, John P. Anagnostakos, Christine M. Jones, John M. Roberts |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Long bone Free Tissue Flaps Fractures Open 03 medical and health sciences 0302 clinical medicine Deformity Humans Medicine Tibia Retrospective Studies Fracture Healing 030222 orthopedics business.industry Soft tissue 030208 emergency & critical care medicine Skin Transplantation Middle Aged Plastic Surgery Procedures Microsurgery Limb Salvage Leg Length Inequality Surgery Tibial Fractures medicine.anatomical_structure Amputation Orthopedic surgery Skin grafting Female medicine.symptom business |
| Zdroj: | Journal of Plastic, Reconstructive & Aesthetic Surgery. 74:2933-2940 |
| ISSN: | 1748-6815 |
| DOI: | 10.1016/j.bjps.2021.03.105 |
| Popis: | Summary Background Ring fixator techniques can precisely correct complex long bone deformities. In select patients, controlled shortening or intentional fracture deformation with delayed correction can also aid in complex wound coverage and limb salvage. Methods This retrospective cohort study analyzed all patients who underwent acute limb shortening or intentional temporary fracture deformation between 2005 and 2020. Patients were divided into three groups based on reason for acute shortening or intentional deformity: (1) skeletal indications alone, with traditional flap coverage; (2) skeletal and soft tissue indications, to augment traditional reconstructive measures; and (3) skeletal and soft tissue indications, to avoid microsurgery altogether. Comorbidities, orthopedic and reconstructive methods, and functional outcomes were recorded. Results Eighteen patients were identified: six in Group 1, five in Group 2, and seven in Group 3. Fractures were primarily in the distal third of the tibia. On initial assessment, all wounds would have required free tissue transfer. Group 1 patients were reconstructed with free flaps. Among Group 2, closure was accomplished by skin grafting (N = 1), local flaps (N = 1), pedicled muscle flaps (N = 1), and free flaps (N = 2). In Group 3, five wounds were closed primarily and two were skin grafted. All limbs were shortened, averaging 25.1 mm; seven were intentionally deformed, most commonly varus (10–20°). After skeletal correction, residual leg length discrepancy averaged 5.7 mm. No patients required amputation. Conclusions Acute skeletal shortening with or without intentional temporary deformation in select IIIB/IIIC open tibial fractures can facilitate soft tissue coverage and limb salvage in patients who might otherwise require amputation. |
| Databáze: | OpenAIRE |
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