Outcomes of tissue reconstruction in distal lower leg fractures: a retrospective cohort study
- PDF / 543,610 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 20 Downloads / 176 Views
(2020) 21:799
RESEARCH ARTICLE
Open Access
Outcomes of tissue reconstruction in distal lower leg fractures: a retrospective cohort study Emrah Aydogan* , Stefan Langer, Christoph Josten, Johannes Karl Maria Fakler and Ralf Henkelmann
Abstract Background: Open and closed fractures can be associated with posttraumatic or postoperative soft tissue defects caused by initial trauma, operative procedures, or infections. This study evaluated the postoperative outcomes in patients with open or closed lower leg fractures, related soft tissue defects, and subsequent flap coverage. Methods: We performed a retrospective single-center cohort study in a level 1 trauma center. We analyzed the patients treated from January 2012 through December 2017 and recorded demographics, treatment, and outcome data. The outcome data were measured via patient-reported Foot and Ankle Outcomes Scores (FAOS) and EQ-5D5L scores. Results: We included 22 patients with complicated fractures (11 open and 11 closed) and subsequent soft tissue defects and flap coverages. The mean follow-up time was 41.2 months. Twenty-one patients developed infections, and necrosis at the site of surgery manifested in all closed fractures. Therefore, all patients needed soft tissue reconstructions. Preoperatively, 16 patients underwent arterial examinations via angiography and six underwent ultrasound examinations of the venous system. Ten patients had complications involving the flaps due to ischemia and consequent necrosis. The mean EQ-5D index was 0.62 ± 0.27, and EQ-5D VAS score was 57.7 ± 20.2. The mean FAOS was 60.7 ± 22.2; in particular, quality of life was 32.3 ± 28.8. The rate of returning to work in our patient group was 37.5% after 1 year. Conclusions: Distal tibial fractures often require revisions and soft tissue reconstruction. The evaluated patient population had poor outcomes in terms of function, quality of life, and return to work. Furthermore, patients suffering from flap ischemia have worse outcomes than those without flap ischemia. Keywords: EQ-5D-5L, Flap coverage, Foot and ankle outcome score, Infection, Lower leg fracture
Background Complex distal lower extremity fractures are frequently associated with soft tissue injuries that require challenging and substantial reconstructions [1]. Therefore, it is of high importance for physicians to identify the right course of treatment. Among available options, bone and soft tissue reconstruction and limb rescue both require * Correspondence: [email protected] Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
long-term treatment and have more potential comorbidities than primary amputation [2]. Complicated fractures can be limb-threatening if the arterial flow is reduced because of swelling, trauma, or compression. Arterial injuries have resulted in significant complications for patients with lower extremity fractures requiring flap coverage; however, limb salvage is still effective in most cases [3]. Before perfor
Data Loading...
