title: [Clinical impact of operative multidisciplinarity for severe defect injuries of the lower extremity].
abstract: BACKGROUND
  The aim of this study was to examine the impact of our multidisciplinary therapeutical concept (MTC) on the clinical outcome in posttraumatic defect injuries of the lower extremity.
  
  
  METHODS
  Since 1999, we have performed a free tissue transfer in 37 patients. In group 1 (n = 21), our MTC was started more than two weeks (range: 17 to 83 days) after trauma and in group 2 (n = 16) within two weeks (range: four to twelve days) after trauma. Both groups were comparable with respect to trauma severity.
  
  
  RESULTS
  100 % patients of group 1 and 25 % patients of group 2 had clinical and microbiological manifestations of wound infection after admission in our clinic. Significantly more operations were necessary in group 1 compared to group 2 (7.3 +/- 2.6 versus 2.9 +/- 0.8; p < 0.05), until definitive wound closure could be achieved. The postoperative course was uneventful in 35 cases. All injured extremities could be salvaged. Multistaged bone reconstructions by means of spongious or tricortical bone from the iliac crest were successful in all cases. Hospital stay after admission to our clinic was significantly longer in group 1 compared to group 2 (57 +/- 12 days versus 31 +/- 7 days, p < 0.05).
  
  
  CONCLUSIONS
  In our study, the early start of MTC significantly reduced the risk for wound infection, the number of surgical revisions before definite wound closure and time until bone and wound healing was completed.
authors.affiliation: Plastische und Handchirurgie, Intensiveinheit für Schwerbrandverletzte, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck. machens@uni-luebeck.de
authors.forename: H-G
authors.initials: HG
authors.lastname: Machens
authors.forename: M
authors.initials: M
authors.lastname: Kaun
authors.forename: T
authors.initials: T
authors.lastname: Lange
authors.forename: H J
authors.initials: HJ
authors.lastname: Egbers
authors.forename: M
authors.initials: M
authors.lastname: Wenzl
authors.forename: A
authors.initials: A
authors.lastname: Paech
authors.forename: B
authors.initials: B
authors.lastname: Reichert
authors.forename: P
authors.initials: P
authors.lastname: Mailänder
mesh_terms: D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation; D003646:Debridement; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D007902:Length of Stay; D023821:Limb Salvage; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D010348:Patient Care Team; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D014945:Wound Healing / Q000502:physiology; D014946:Wound Infection / Q000601:surgery*