Evaluation of the Emergency Management Strategy for Gustilo IIIB Open Leg Fractures

Seance of wednesday 08 june 2016 (CHIRURGIE PLASTIQUE, ORTHOPÉDIQUE ET RÉPARATRICE)

DOI number : 10.2699/wqv0-yw92/emem.2017.3.002

Abstract

Objective: Gustilo IIIB open leg fractures have a major multi tissular impact. Our emergency therapeutic strategy consists in a wide wound debridement of all devitalized tissues, internal stabilization of the skeleton with bone graft if necessary, combined with a muscular flap according to the principle of «all in one time» or «fix and flap». We wanted to evaluate the results of this treatment.
Methods: A retrospective monocentric study was carried out over the 1985-2015 period, concerning 41 patients. We recorded septic complications, bone healing time and long-term functional results.
Results: We performed 14 free flaps (mean age 38,1 year) and 27 pedicled flaps (40,1 year), as well as the installation of 37 nails and 4 plates. Thirty-nine patients were followed until consolidation. We report 3 cases of septic complications (7,5%). No amputation was necessary. The mean follows up was 14,1 years. The bone union time was 6,7 months in the free flap group versus 8,1 months for pedicled flaps (p=0,36). We noted good joint recovery of the knee and the presence of 3 equinus deformity. The socio professional reintegration was good (90% and 68,7%). The majority of patients were satisfied.
Conclusion: Our strategy allows a definitive soft tissue reconstruction making early rehabilitation possible. The septic complications rate seems to be influenced by the success of emergency soft tissue reconstruction.