[Modern Concepts of Interdisciplinary Extremity Reconstruction in Open Fractures]

Overview

Journal Unfallchirurgie (Heidelb)

Specialty Emergency Medicine

Date 2024 May 13

PMID 38739196

Authors

Benjamin Thomas

Roslind K Hackenberg

Demir Krasniqi

Amr Eisa

Arne Bocker

Emre Gazyakan

Amir K Bigdeli

Ulrich Kneser

Leila Harhaus-Wahner

Affiliations

Soon will be listed here.

Abstract

The orthoplastic approach involves the collaboration of orthopedic/trauma surgeons, vascular surgeons and reconstructive microsurgeons. In cases of complex limb fractures, the aims are to optimize blood flow, restore bone stability, reconstruct soft tissue defects, and enhance function and sensitivity. The early administration of antibiotics and a timely, high-quality debridement after initial interdisciplinary assessment are carried out. This is followed by fracture stabilization and temporary wound coverage in order to plan the definitive interdisciplinary procedure. This includes definitive osteosynthesis and soft tissue reconstruction, using local tissue transfer if feasible, or free tissue transfer in cases of extensive trauma zones. The orthoplastic approach allows for faster definitive stabilization, fewer operations, shorter hospital stays, lower complication and revision rates, higher cost-effectiveness and improved long-term function.

References

Boriani F, Haq A, Baldini T, Urso R, Granchi D, Baldini N . Orthoplastic surgical collaboration is required to optimise the treatment of severe limb injuries: A multi-centre, prospective cohort study. J Plast Reconstr Aesthet Surg. 2017; 70(6):715-722. DOI: 10.1016/j.bjps.2017.02.017. View

Tukiainen E, Kallio M, Lepantalo M . Advanced leg salvage of the critically ischemic leg with major tissue loss by vascular and plastic surgeon teamwork: Long-term outcome. Ann Surg. 2006; 244(6):949-57. PMC: 1856637. DOI: 10.1097/01.sla.0000247985.45541.e8. View

Gustilo R, Mendoza R, Williams D . Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984; 24(8):742-6. DOI: 10.1097/00005373-198408000-00009. View

MacKenzie E, Bosse M, Kellam J, Burgess A, Webb L, Swiontkowski M . Factors influencing the decision to amputate or reconstruct after high-energy lower extremity trauma. J Trauma. 2002; 52(4):641-9. DOI: 10.1097/00005373-200204000-00005. View

Bosse M, McCarthy M, Jones A, Webb L, Sims S, Sanders R . The insensate foot following severe lower extremity trauma: an indication for amputation?. J Bone Joint Surg Am. 2005; 87(12):2601-2608. DOI: 10.2106/JBJS.C.00671. View

Enechukwu A, Stogner V, Vogt P . [Autologous tissue reconstruction of the lower extremity-indications and technique]. Chirurgie (Heidelb). 2022; 93(10):1007-1018. DOI: 10.1007/s00104-021-01566-8. View

Schmidt V, Hirsch T, Osinga R, Kotsougiani D, Schaefer D, Pierer G . [The interdisciplinary Microsurgeon - Results of the Consensus Workshop of the German Speaking Society for Microsurgery of Peripheral Nerves and Vessels]. Handchir Mikrochir Plast Chir. 2019; 51(4):295-301. DOI: 10.1055/a-0874-2159. View

GODINA M . Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg. 1986; 78(3):285-92. DOI: 10.1097/00006534-198609000-00001. View

Levin L . The reconstructive ladder. An orthoplastic approach. Orthop Clin North Am. 1993; 24(3):393-409. View

10.

Trickett R, Rahman S, Page P, Pallister I . From guidelines to standards of care for open tibial fractures. Ann R Coll Surg Engl. 2015; 97(6):469-75. PMC: 5126246. DOI: 10.1308/rcsann.2015.0020. View

11.

Ylitalo A, Hurskainen H, Repo J, Kiiski J, Suomalainen P, Kaartinen I . Implementing an orthoplastic treatment protocol for open tibia fractures reduces complication rates in tertiary trauma unit. Injury. 2023; 54(8):110890. DOI: 10.1016/j.injury.2023.110890. View

12.

Hoyt B, Wade S, Harrington C, Potter B, Tintle S, Souza J . Institutional Experience and Orthoplastic Collaboration Associated with Improved Flap-based Limb Salvage Outcomes. Clin Orthop Relat Res. 2021; 479(11):2388-2396. PMC: 8509985. DOI: 10.1097/CORR.0000000000001925. View

13.

Bocker A, Gramlich Y, Hoffmann R, Hirche C, Gather A, Grutzner P . . Z Orthop Unfall. 2022; 160(6):607-612. DOI: 10.1055/a-1924-6581. View

14.

Rupp M, Walter N, Popp D, Hitzenbichler F, Heyd R, Geis S . Multidisciplinary Treatment of Fracture-Related Infection Has a Positive Impact on Clinical Outcome-A Retrospective Case Control Study at a Tertiary Referral Center. Antibiotics (Basel). 2023; 12(2). PMC: 9952612. DOI: 10.3390/antibiotics12020230. View

15.

Konda S, Lack W, Seymour R, Karunakar M . Mechanism of Injury Differentiates Risk Factors for Mortality in Geriatric Trauma Patients. J Orthop Trauma. 2015; 29(7):331-6. DOI: 10.1097/BOT.0000000000000281. View

16.

Roddy E, Patterson J, Kandemir U . Delay of Antibiotic Administration Greater than 2 Hours Predicts Surgical Site Infection in Open Fractures. Injury. 2020; 51(9):1999-2003. DOI: 10.1016/j.injury.2020.04.031. View

17.

Schwabe P, Haas N, Schaser K . [Fractures of the extremities with severe open soft tissue damage. Initial management and reconstructive treatment strategies]. Unfallchirurg. 2010; 113(8):647-70. DOI: 10.1007/s00113-010-1801-0. View

18.

Wu C, Velazquez-Mujica J, Donfrancesco A, Lee J, Chen H . Classification of the Conjoined Latissimus Dorsi-Groin Flap and Indications for the Four Types of the Flap. Plast Reconstr Surg. 2024; 153(3):632e-635e. DOI: 10.1097/PRS.0000000000010812. View

19.

Cholok D, Saberski E, Lowenberg D . Approach to Complex Lower Extremity Reconstruction. Semin Plast Surg. 2022; 36(4):233-242. PMC: 9762997. DOI: 10.1055/s-0042-1758205. View

20.

Morgenstern M, Vallejo A, McNally M, Moriarty T, Ferguson J, Nijs S . The effect of local antibiotic prophylaxis when treating open limb fractures: A systematic review and meta-analysis. Bone Joint Res. 2018; 7(7):447-456. PMC: 6076360. DOI: 10.1302/2046-3758.77.BJR-2018-0043.R1. View