A study of clinical outcome and patient quality of life in timing of free flap cover in type IIIB open fractures
DOI:
https://doi.org/10.18203/2349-2902.isj20195596Keywords:
Free flap timing, Type IIIB fracture of the leg, Gustilo Anderson classification, Patient quality of life, Lower limb fractureAbstract
Background: Open fractures of leg classified under type IIIB, those requiring free flap cover could be done as emergency procedure. The ideal timing has still remained controversial. Although it appears imperative to operate early and reduce length of hospital stay, costs, disability adjusted life years and put the patient back on his feet, our study was necessitated in the context of differing views regarding ideal timing of free flap.
Methods: The prospective observational study was conducted for duration of 4 years between October 2015 to September 2019. Patients were taken up for free flap cover after optimization for the major surgery. Details of flap complications and the procedures for salvage were noted. At the end of one year following the injury, patient quality of life (PQOL) was tabulated for all patients.
Results: Most common mode of injury was road traffic accidents. Early flaps were done in 28 and primary flaps in 22 patients. One patient had partial flap necrosis while 7 others had sub flap collections and partial flap necrosis. Duration of hospitalization was significantly lower in early flap cover group. PQOL measured with EQ-5D (EuroQol 5D) was significantly higher in the early flap covers.
Conclusions: From our study we concluded that timing of free flap cover positively influenced clinical outcome of reduced hospitalization, although there was no relation of timing of free flap to flap or bone complications. The functional outcome measured by PQOL was significantly higher in patients who had microvascular reconstruction early.
References
Dandona R, Kumar GA, Ameer MA, Ahmed GM, Dandona L. Incidence and burden of road traffic injuries in urban India. Inj Prev. 2008;14(6):354-9.
World Health Organization The Injury Chartbook:a graphical overview of the global burden of injuries. Available at: http://www.who.int/violence_injury_ prevention/publications/other_injury/chartb/en. Accessed on 25 November 2018.
Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures:a new classification of type III open fractures. J Trauma. 1984;24:742-6.
Behrens F, Searls K. Unilateral external fixation: experience with the ASIF “tubular” frame. Uhthoff HK (ed), Current Concepts of External Fixation of Fractures. Berlin Heidelberg New York: Springer-Verlag; 1982: 177-183.
Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg. 1986;78:285-92.
Harrison BL, Lakhiani C, Lee MR, Saint-Cyr M. Timing of traumatic upper extremity free flap reconstruction: A systematic review and progress report. Plast Reconstr Surg. 2013;132(3):591-6.
Hill JB, Vogel JE, Sexton KW, Guillamondegui OD, Corral GA, Shack RB. Re-evaluating the paradigm of early free flap coverage in lower extremity trauma. Microsurgery. 2013;33(1):9-13.
Melissinos EG, Parks DH. Post trauma reconstruction with free tissue transfer:Analysis of 442 consecutive cases. J Trauma. 1989;29:1095-102.
Karanas YL, Nigriny J, Chang J. The timing of microsurgical reconstruction in lower extremity trauma. Microsurgery. 2008;28(8):632-4.
Francel T, Vanderkolk C, Hoopes J. Microvascular soft-tissue transplantation for reconstruction of acute open tibial fractures: Timing of coverage and long term functional results. Plast Reconstr Surg. 1992;89:478-87.
Hertel R, Lambert S, Muller S. On the timing of soft-tissue reconstruction for open fractures of the lower leg. Arch Orthop Trauma Surg. 1999;119:7-12.
Byrd HS, Spicer TE, Cierney G. Management of open tibial fractures. Plast Reconstr Surg. 1985;76(5):719-30.