title: Free tissue coverage of chronic traumatic wounds of the lower leg.
abstract: Thirty-eight consecutive patients who underwent 42 free flaps for chronic wounds of the lower leg were identified over an 11-year period. All wounds were open for a minimum of 1 month (mean, 40 months; median, 8 months; range, 1 month to 30 years). The average age was 37 years (range, 7 to 68 years), there were 31 male patients and seven female patients, and the average follow-up time was 30 months (range, 12 to 72 months). The original injury was an open fracture in 28 patients, wound dehiscence after open reduction and internal fixation of a closed fracture in nine patients, and a shrapnel wound in one patient. A total of 23 patients had osteomyelitis, which was classified as local (involving less than 50 percent of the bone diameter) in 15 patients and as diffuse (involving greater than 50 percent of the bone diameter or infected nonunion) in eight patients. The wounds were treated with sequential debridement, antibiotics, and flap coverage. Ancillary procedures included antibiotic beads in 18 patients, saucerization in 16, Ilizarov bone transport in three, calcanectomy in two, and fibular resection and ankle fusion in one. Thirty-four of 42 flaps survived, four having undergone a repeat free flap. There were three failures out of 25 flaps (12 percent) among those with a normal angiogram and five failures out of 15 flaps (33 percent) among those with an abnormal angiogram (p > 0.05). The failure rate of those with osteomyelitis was six of 26 (23 percent) versus two of 26 (13 percent) for those without osteomyelitis (p > 0.05). Successful reconstruction (bone healed, patient ambulatory and infection-free) was achieved in 33 of 38 patients (87 percent). The failure of reconstruction for those patients with osteomyelitis was four of 23 (22 percent) versus one of 15 (7 percent) for others (p > 0.05). The failure rate of flaps in patients with diffuse osteomyelitis was three of eight (38 percent) versus two of 30 for others (7 percent, p = 0.053). The presence of diffuse osteomyelitis was associated with a lower rate of successful limb reconstruction. An abnormal angiogram and the presence of osteomyelitis both were associated with a lower rate of successful limb reconstruction, but this was not significant, probably because of the small size of the cohort.
authors.affiliation: Division of Orthopedic Surgery, Cook County Hospital, Chicago, IL 60612, USA. Hand15@aol.com
authors.forename: Mark H
authors.initials: MH
authors.lastname: Gonzalez
authors.forename: Dana I
authors.initials: DI
authors.lastname: Tarandy
authors.forename: Daniel
authors.initials: D
authors.lastname: Troy
authors.forename: Dawn
authors.initials: D
authors.lastname: Phillips
authors.forename: Norman
authors.initials: N
authors.lastname: Weinzweig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002908:Chronic Disease; D003646:Debridement; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D005597:Fractures, Open / Q000150:complications; D006085:Graft Survival; D006801:Humans; D007866:Leg / Q000601:surgery*; D007869:Leg Injuries / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology / Q000601:surgery; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000601:surgery; D017211:Treatment Failure; D014946:Wound Infection / Q000382:microbiology; D014948:Wounds, Gunshot / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents