[Literature and own strategies concerning soft-tissue reconstruction and exposed osteosynthetic hardware].
BACKGROUND
In the event of exposed hardware from reconstructive surgery, it must be decided whether to retain or remove it prior to plastic surgical soft-tissue reconstruction to ensure long-term freedom from infection and stable wound closure.


METHODS
Treatment options and results in the literature are reviewed. A treatment algorithm is proposed under consideration of our personal experience.


CONCLUSIONS
Hardware used in spine surgery is commonly left in situ until bony consolidation has been achieved. The indications for hardware removal depend on length of exposure or infection, implant failure, and location. Osteosynthetic devices in the extremities may be removed and replaced by external fixators or immobilisation. Removal of prostheses requires complex second-stage reimplantation or arthrodesis. A treatment algorithm is suggested that might ease the decision whether exposed hardware can remain or requires removal before reconstruction of soft-tissue defects.
Baumeister
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S
Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA. stbaumeister@yahoo.com
Levin
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LS
Erdmann
D
D
D000465:Algorithms; D001174:Arthrodesis; D020878:Device Removal; D016267:External Fixators; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures; D012307:Risk Factors; D018461:Soft Tissue Infections / Q000517:prevention & control / Q000601:surgery; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps; D013997:Time Factors; D014945:Wound Healing