Wound surface area as a risk factor for flap complications among patients with open fractures

Authors

Phelan Shea, Baltimore
Nathan N. O'Hara, Baltimore
Sheila A. Sprague, Baltimore
Mohit Bhandari, Baltimore
Brad A. Petrisor, Baltimore
Kyle J. Jeray, Baltimore
Min Zhan, Baltimore
Gerard P. Slobogean, Baltimore
Raymond A. Pensy, Baltimore
Gordon H. Guyatt, McMaster University
Stephen D. Walter, McMaster University
Emil H. Schemitsch, Saint Michael's Hospital University of Toronto
Paul Tornetta, Boston University Medical Center
Jeff Anglen, Indiana University Bloomington
Michael Bosse, Carolinas Health Care System
Susan Liew, The Alfred
Parag Sancheti, Sancheti Institute for Orthopaedics and Rehabilitation
Paula McKay, McMaster University
Kim Madden, McMaster University
Kerry Tai, McMaster University
Diane Heels-Ansdell, McMaster University
Lisa Buckingham, McMaster University
Aravin Duraikannan, McMaster University
Stephanie L. Tanner, Greenville Hospital System
Rebecca G. Snider, Greenville Hospital System
Douglas Altman, University of Oxford
Rajiv Gandhi, Toronto Western Hospital University of Toronto
Markus Bischoff, McMaster University
Gregory J.Della Rocca, University of Missouri
Bill Ristevski, Hamilton Health Sciences
Krishan Rajaratnam, Hamilton Health Sciences
Dale Williams, Hamilton Health Sciences
Matthew Denkers, Hamilton Health Sciences

Document Type

Article

Publication Date

1-1-2018

Journal

Plastic and Reconstructive Surgery

Volume

142

Issue

1

First Page

228

Last Page

236

URL with Digital Object Identifier

10.1097/PRS.0000000000004418

Abstract

Copyright © 2018 by the American Society of Plastic Surgeons. 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.