Abstract
Background: Soft-tissue complications often dictate the success of limb salvage and the overall outcome of open fractures. Based on prior work at the R Adams Cowley Shock Trauma Center, the authors hypothesize that wounds larger than 200 cm2 are associated with a greater likelihood of both flap-related reoperation and wound complications among patients requiring soft-tissue reconstruction with a rotational flap or free tissue transfer. Methods: This study was a secondary analysis of Fluid Lavage in Open Wounds trial data that included all patients who received a rotational or free tissue flap transfer for an open fracture. The primary outcome was flap-related reoperation within 12 months of injury. The secondary outcome was wound complication, which included events treated operatively or nonoperatively. Multivariable logistic regression was used to assess the association between wound size and outcomes, adjusting for confounders. Results: Seventeen percent of the 112 patients required a flap-related reoperation. A wound size greater than 200 cm2 was not associated with reoperation in an unadjusted model (p = 0.64) or adjusting for Gustilo type (p = 0.70). The sample had an overall wound complication rate of 47.3 percent. Patients with a wound size of greater than 200 cm2 were three times more likely to experience wound complications (OR, 3.05; 95 percent CI, 1.08 to 8.62; p = 0.04) when adjusting for moderate to severe wound contamination and wound closure in the operating room. Conclusion: The findings of this study demonstrate that wound surface area is an integral determinant for wound complication following soft-tissue flap treatment, but found no association between wound surface area and flap-related reoperation rates.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 228-236 |
| Number of pages | 9 |
| Journal | Plastic and reconstructive surgery |
| Volume | 142 |
| Issue number | 1 |
| DOIs | |
| State | Published - 2018 |
| Externally published | Yes |
ASJC Scopus subject areas
- Surgery
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In: Plastic and reconstructive surgery, Vol. 142, No. 1, 2018, p. 228-236.
Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Wound surface area as a risk factor for flap complications among patients with open fractures
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AU - O'Hara, Nathan N.
AU - Sprague, Sheila A.
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AU - Pensy, Raymond A.
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AU - Anglen, Jeff
AU - Bosse, Michael
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AU - McKay, Paula
AU - Madden, Kim
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AU - Heels-Ansdell, Diane
AU - Buckingham, Lisa
AU - Duraikannan, Aravin
AU - Tanner, Stephanie L.
AU - Snider, Rebecca G.
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AU - Gandhi, Rajiv
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AU - Denkers, Matthew
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AU - Sadler, John
AU - Kwok, Desmond
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AU - Wong, Ivan
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AU - McKee, Michael D.
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AU - Whelan, Daniel
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AU - Daniels, Timothy
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AU - Vicente, Milena R.
AU - Hidy, Jennifer T.
AU - Sanders, David
AU - Lawendy, Abdel Rahman
AU - Gurr, Kevin
AU - Carey, Timothy
AU - Bailey, Chris
AU - Macleod, Mark
AU - Bartley, Debra
AU - Tieszer, Christina
AU - Coles, Chad
AU - Leighton, Ross
AU - Richardson, C. Glen
AU - Biddulph, Michael
AU - Gross, Michael
AU - Dunbar, Michael
AU - Amirault, J. David
AU - Alexander, David
AU - Coady, Catherine
AU - Glazebrook, Mark
AU - Johnston, David
AU - Oxner, William
AU - Trenholm, J. Andrew
AU - Reardon, Gerald
AU - Trask, Kelly
AU - MacDonald, Shelley
AU - Papp, Steven
AU - Gofton, Wade
AU - Kingwell, Stephen
AU - O'Neill, Joseph
AU - Johnson, Garth
AU - Wai, Eugene
AU - Foxall, Julia
AU - Broekhuyse, Henry M.
AU - O'Brien, Peter J.
AU - Blachut, Piotr A.
AU - Lefaivre, Kelly A.
AU - Johal, Raman
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AU - Malo, Michel
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AU - Berry, Greg
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AU - Tanzer, Michael
AU - Talbot, Max
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AU - Apostle, Kelly
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AU - Howells, Fiona
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AU - Cabana, François
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AU - Earles, Melissa M.
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AU - Pourmand, Deeba
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AU - Chia, Andrew
AU - Curry, Hamish
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AU - Dowrick, Adam
AU - Clarke-Jenssen, John
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AU - Lippert, Anders
AU - Sletten, Ida
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AU - Aga, Cathrine
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AU - Flugsrud, Gunnar
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AU - Flatoy, Bernhard
AU - Furunes, Havard
AU - Bogsti, Peder
AU - Ekås, Guri
AU - Moatshe, Gilbert
AU - Al-Ashtari, Ali
AU - Fjalestad, Tore
AU - Nilsen, Fredrik
AU - Smedsrud, Morten
AU - Brekke, Anne Christine
AU - Vesterhus, Elise Berg
AU - Knuts, Sissel
AU - Rocha, Steve
AU - Puram, Chetan
AU - Patil, Atul
AU - Jhangiani, Neelam
AU - Rai, Anil K.
AU - Rai, Kamal Narayan
AU - Jabade, Vivek V.
AU - Nassikars, Deepali
AU - Karne, Narayan J.
AU - Metha, Chetan
AU - Shankar, A. Navaladi
AU - Navaladi Shankar, A.
AU - Saravana, R.
AU - Gupta, Ajay
AU - Jain, Neeraj
AU - Bhatia, Mahesh
AU - Arora, Vinod
AU - Tyagi, Vivek
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N1 - Publisher Copyright: Copyright © 2018 by the American Society of Plastic Surgeons.
PY - 2018
Y1 - 2018
N2 - Background: Soft-tissue complications often dictate the success of limb salvage and the overall outcome of open fractures. Based on prior work at the R Adams Cowley Shock Trauma Center, the authors hypothesize that wounds larger than 200 cm2 are associated with a greater likelihood of both flap-related reoperation and wound complications among patients requiring soft-tissue reconstruction with a rotational flap or free tissue transfer. Methods: This study was a secondary analysis of Fluid Lavage in Open Wounds trial data that included all patients who received a rotational or free tissue flap transfer for an open fracture. The primary outcome was flap-related reoperation within 12 months of injury. The secondary outcome was wound complication, which included events treated operatively or nonoperatively. Multivariable logistic regression was used to assess the association between wound size and outcomes, adjusting for confounders. Results: Seventeen percent of the 112 patients required a flap-related reoperation. A wound size greater than 200 cm2 was not associated with reoperation in an unadjusted model (p = 0.64) or adjusting for Gustilo type (p = 0.70). The sample had an overall wound complication rate of 47.3 percent. Patients with a wound size of greater than 200 cm2 were three times more likely to experience wound complications (OR, 3.05; 95 percent CI, 1.08 to 8.62; p = 0.04) when adjusting for moderate to severe wound contamination and wound closure in the operating room. Conclusion: The findings of this study demonstrate that wound surface area is an integral determinant for wound complication following soft-tissue flap treatment, but found no association between wound surface area and flap-related reoperation rates.
AB - Background: Soft-tissue complications often dictate the success of limb salvage and the overall outcome of open fractures. Based on prior work at the R Adams Cowley Shock Trauma Center, the authors hypothesize that wounds larger than 200 cm2 are associated with a greater likelihood of both flap-related reoperation and wound complications among patients requiring soft-tissue reconstruction with a rotational flap or free tissue transfer. Methods: This study was a secondary analysis of Fluid Lavage in Open Wounds trial data that included all patients who received a rotational or free tissue flap transfer for an open fracture. The primary outcome was flap-related reoperation within 12 months of injury. The secondary outcome was wound complication, which included events treated operatively or nonoperatively. Multivariable logistic regression was used to assess the association between wound size and outcomes, adjusting for confounders. Results: Seventeen percent of the 112 patients required a flap-related reoperation. A wound size greater than 200 cm2 was not associated with reoperation in an unadjusted model (p = 0.64) or adjusting for Gustilo type (p = 0.70). The sample had an overall wound complication rate of 47.3 percent. Patients with a wound size of greater than 200 cm2 were three times more likely to experience wound complications (OR, 3.05; 95 percent CI, 1.08 to 8.62; p = 0.04) when adjusting for moderate to severe wound contamination and wound closure in the operating room. Conclusion: The findings of this study demonstrate that wound surface area is an integral determinant for wound complication following soft-tissue flap treatment, but found no association between wound surface area and flap-related reoperation rates.
UR - http://www.scopus.com/inward/record.url?scp=85056942077&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85056942077&partnerID=8YFLogxK
U2 - 10.1097/PRS.0000000000004418
DO - 10.1097/PRS.0000000000004418
M3 - Article
C2 - 29608532
AN - SCOPUS:85056942077
SN - 0032-1052
VL - 142
SP - 228
EP - 236
JO - Plastic and reconstructive surgery
JF - Plastic and reconstructive surgery
IS - 1
ER -