Impact of Early Soft Tissue Coverage on Outcomes of Complex Fractures: An Orthoplastic Perspective

Abstract

Objective: To determine the effects of definitive soft tissue coverage timing on clinical outcomes of patients undergoing an integrated orthoplastic management of Gustilo-Anderson Type IIIB/ IIIC open fractures.

MATERIALS and METHODS: It was a prospective cohort study, which recruited 186 patients with complex lower limb fractures that necessitated soft tissue repair. Patients were divided into two categories, depending on when they received definitive flap coverage Group A (early coverage ≤ 7 days, n=98) and Group B (delayed coverage >7 days, n=88). Deep infection rate, time to bony union, flap survival and limb salvage were the primary outcomes. The secondary outcomes were hospital length of stay, reoperation rate, and functional outcome measured using Lower Extremity Functional Scale (LEFS).

Results: At early stages, the rates of deep infection (12.2 vs. 34.1, p=0.001), flap survival (96.9 vs. 85.2, p=0.008), bony union (18.4+-4.2 vs. 24.7+-6.8 weeks, p=0.001), and length of stay (22.3+-7.1 vs. 31.8+-9.4 days, p=0.001) showed significant differences. The coverage timing (>7 days) was determined as an independent predictor of a deep infection by the multivariate logistic regression when adjusted by the severity of injuries, comorbidities and smoking status (OR 3.82, 95% CI 1.94-7.53, p<0.001).

Conclusion: Early definitive soft tissue coverage in the initial seven days of management makes a big contribution to clinical outcomes of complex open fractures using an orthoplastic model. Morbidity reduction can be optimized through socioeconomic challenges by implementing special orthoplastic teams in resource-constrained environments such as Pakistan.