title: Early soft tissue coverage and negative pressure wound therapy optimises patient outcomes in lower limb trauma.
abstract: BACKGROUND
  The timing of soft tissue reconstruction for severe open lower limb trauma is critical to its successful outcome, particularly in the setting of exposed metalware and pre-existing wound infection. The use of negative pressure wound therapy (NPWT) may allow a delay in soft tissue coverage without adverse effects. This study evaluated the impact of delayed free-flap reconstruction, prolonged metalware exposure, pre-flap wound infection, and the efficacy of NPWT on the success of soft tissue coverage after open lower limb injury.
  
  
  METHODS
  Retrospective review of all free-flap reconstructions for lower limb trauma undertaken at a tertiary trauma centre between June 2002 and July 2009.
  
  
  RESULTS
  103 patients underwent 105 free-flap reconstructions. Compared with patients who were reconstructed within 3 days of injury, the cohort with delayed reconstruction beyond 7 days had significantly increased rates of pre-flap wound infection, flap re-operation, deep metal infection and osteomyelitis. Pre-flap wound infection independently predicted adverse surgical outcomes. In the setting of exposed metalware, free-flap transfer beyond one day significantly increased the flap failure rate. These patients required more surgical procedures and a longer hospital stay. The use of NPWT significantly lowered the rate of flap re-operations and venous thrombosis, but did not allow a delay in reconstruction beyond 7 days from injury without a concomitant rise in skeletal and flap complications.
  
  
  CONCLUSIONS
  Following open lower limb trauma, soft tissue coverage within 3 days of injury and immediately following fracture fixation with exposed metalware minimises pre-flap wound infection and optimises surgical outcomes. NPWT provides effective temporary wound coverage, but does not allow a delay in definitive free-flap reconstruction.
authors: Department of Plastics and Reconstructive Surgery, The Royal Melbourne Hospital, Australia.
authors: David Shi Hao
authors: DS
authors: Liu
authors: Foti
authors: F
authors: Sofiadellis
authors: Mark
authors: M
authors: Ashton
authors: Kirstie
authors: K
authors: MacGill
authors: Angela
authors: A
authors: Webb
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001315:Australia; D015331:Cohort Studies; D003646:Debridement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005597:Fractures, Open / Q000150:complications / Q000601:surgery* / Q000628:therapy; D006801:Humans; D015601:Injury Severity Score; D035002:Lower Extremity / Q000293:injuries* / Q000503:physiopathology; D008297:Male; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D010019:Osteomyelitis / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000150:complications / Q000601:surgery* / Q000628:therapy; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D000900:Anti-Bacterial Agents