Sommar Pehr, Granberg Yamin, Halle Martin, Skogh Ann-Charlott Docherty, Lundgren Kalle T, Jansson Karl-Åke
Department of Molecular Medicine and Surgery, Section of Plastic Surgery, Karolinska Institutet and Karolinska University Hospital Stockholm, Stockholm, Sweden.
Department of Orthopedic Surgery Västerås Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet Stockholm, Stockholm, Sweden.
J Trauma Manag Outcomes. 2015 Apr 15;9:3. doi: 10.1186/s13032-015-0023-4. eCollection 2015.
Severe trauma to the extremities often includes a combination of fractures and soft tissue injuries. Several publications support that the patient outcome is better when skeletal stabilization is followed by early soft-tissue coverage. In an effort to optimize the treatment of these patients, we established a formalized collaboration in 2008 between the Departments of reconstructive plastic surgery and orthopedics at the Karolinska University Hospital.
A retrospective review was conducted for all patients who had suffered severe extremity trauma and received either a free or a pedicled flap for extremity reconstruction. We compared the management of patients 0-4 years before and 0-4 years after the collaboration started especially with respect to; choice of flap, time to flap coverage, number of operations/revisions, total in-hospital stay.
After initiation of the collaboration, the number of flaps increased from 13 flaps (5 free and 8 pedicled) to 44 flaps (21 free and 23 pedicled). Fewer postoperative revisions was seen, as well as shorter in-hospital stay.
The present study highlights the importance of formalized collaboration between orthopedic and plastic surgeons in severe extremity trauma patients. The concept of an interdisciplinary approach has led to an increased number of trauma patients referred for plastic surgical consultation, an increased number of flaps, fewer postoperative revisions and shorter hospital stay.
四肢严重创伤通常包括骨折和软组织损伤。多项研究表明，骨骼稳定后早期进行软组织覆盖，患者预后更佳。为优化此类患者的治疗，2008年卡罗林斯卡大学医院重建整形科与骨科建立了正式合作关系。
对所有遭受四肢严重创伤并接受游离或带蒂皮瓣进行四肢重建的患者进行回顾性研究。我们比较了合作开始前0至4年与开始后0至4年患者的治疗情况，尤其在皮瓣选择、皮瓣覆盖时间、手术/修复次数、住院总时长方面。
合作开始后，皮瓣数量从13个（5个游离皮瓣和8个带蒂皮瓣）增加到44个（21个游离皮瓣和23个带蒂皮瓣）。术后修复次数减少，住院时间缩短。
本研究强调了整形外科医生与骨科医生在四肢严重创伤患者中进行正式合作的重要性。跨学科方法的理念使得转介至整形外科咨询的创伤患者数量增加、皮瓣数量增加、术后修复次数减少且住院时间缩短。
