Alexis D Rounds1, Karen E Burtt1, Hyuma A Leland2, Ram K Alluri3, Ido Badash1, Ketan M Patel2, Joseph N Carey2. 1. Keck School of Medicine of University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, United States. 2. Department of Plastic Surgery, Los Angeles County + University of Southern California Medical Center, 1983 Marengo St, Los Angeles, CA 90033, United States. 3. Department of Orthopedic Surgery, Los Angeles County + University of Southern California Medical Center, 1983 Marengo St, Los Angeles, CA 90033, United States.
Abstract
BACKGROUND: Lower extremity trauma accounts for over 300,000 injuries annually. While soft tissue transfer is a well-accepted practice for open fracture coverage, functional outcomes remain unclear. HYPOTHESIS: This study investigates functional outcomes following soft tissue reconstruction for open tibial fractures. MATERIALS AND METHODS: A retrospective review of a prospectively maintained database of open tibia fractures requiring soft tissue reconstruction was performed at an urban level 1 trauma center between October 2013 and March 2015. OUTCOMES: were evaluated using Pearson's chi square test with significant p value < 0.05. RESULTS: In 30 patients, fractures were graded Gustilo-Anderson type I (3.3%), 30% type II, 3.3% type IIIa, 53.3% type IIIb, and 10% type IIIc. Fixation was 56.7% plate and screw, 20% intramedullary nail, and 16.7% external fixator. Definitive closure was achieved in 43.3% through local rotational flap (38.5% gastrocnemius, 61.5% soleus), and in 56.7% by free tissue transfer (29.4% latissimus, 23.5% rectus, 17.6% ALT, 17.6% gracilis). In 10 patients, 70% returned to full ambulation, 30% required an assistance device, and 50% achieved union in 6 months. Local flap use was predictive of ambulation at discharge. DISCUSSION: Following lower extremity fracture, 70% of patients returned to pre-injury function. Use of a local tissue flap was associated with early ambulation.
BACKGROUND: Lower extremity trauma accounts for over 300,000 injuries annually. While soft tissue transfer is a well-accepted practice for open fracture coverage, functional outcomes remain unclear. HYPOTHESIS: This study investigates functional outcomes following soft tissue reconstruction for open tibial fractures. MATERIALS AND METHODS: A retrospective review of a prospectively maintained database of open tibia fractures requiring soft tissue reconstruction was performed at an urban level 1 trauma center between October 2013 and March 2015. OUTCOMES: were evaluated using Pearson's chi square test with significant p value < 0.05. RESULTS: In 30 patients, fractures were graded Gustilo-Anderson type I (3.3%), 30% type II, 3.3% type IIIa, 53.3% type IIIb, and 10% type IIIc. Fixation was 56.7% plate and screw, 20% intramedullary nail, and 16.7% external fixator. Definitive closure was achieved in 43.3% through local rotational flap (38.5% gastrocnemius, 61.5% soleus), and in 56.7% by free tissue transfer (29.4% latissimus, 23.5% rectus, 17.6% ALT, 17.6% gracilis). In 10 patients, 70% returned to full ambulation, 30% required an assistance device, and 50% achieved union in 6 months. Local flap use was predictive of ambulation at discharge. DISCUSSION: Following lower extremity fracture, 70% of patients returned to pre-injury function. Use of a local tissue flap was associated with early ambulation.