Ardehali B, Geoghegan L, Khajuria A, Reissis D, Lawton G, Jain A, Simmons J, Naique S, Bhattacharya R, Pearse M, Nathwani D, Hettiaratchy S
Department of Plastic & Reconstructive Surgery, Imperial College Healthcare NHS Trust, Praed Street, W2 1NY, London, United Kingdom.
Department of Orthopaedic Surgery, Imperial College Healthcare NHS Trust, Praed Street, W2 1NY, London, United Kingdom.
JPRAS Open. 2017 Nov 21;15:36-45. doi: 10.1016/j.jpra.2017.09.003. eCollection 2018 Mar.
Open extremity fractures carry a high risk of limb loss and poor functional outcomes. Transfer of extremity trauma patients from developing countries and areas of conflict adds further layers of complexity due to challenges in the delivery of adequate care. The combination of extensive injuries, transfer delays and complex microbiology presents unique challenges.
A retrospective review was conducted to analyse the surgical and microbiological themes of patients with open extremity fractures transferred from overseas to our institution (Imperial College NHS Trust) between January 2011 and January 2016.
Twenty civilian patients with 21 open extremity fractures were referred to our unit from 11 different countries. All patients had poly-microbial wound contamination on initial surveillance cultures. Five patients (25%) underwent amputation depending on the extent of osseous injury; positive surveillance cultures did not preclude limb reconstruction, with seven patients undergoing complex reconstruction and eight undergoing simple reconstruction to achievewound coverage. Hundred percent of patients demonstrated infection-free fracture union on discharge.
Patients with open extremity fractures transferred from overseas present the unique challenge of poly-microbial infection in addition to extensive traumatic wounds. Favourable outcomes can be achieved despite positive microbiological findings on tissue culture with adequate antimicrobial therapy. The decision to salvage the limb and the complexity of reconstruction used should be based on the chance of achieving meaningful functional recovery, mainly determined by the extent of bony injury. The complexity of reconstruction was based on the predicted long-term functionality of the salvaged limb.
开放性四肢骨折导致肢体丧失和功能预后不良的风险很高。由于在提供充分治疗方面存在挑战，将四肢创伤患者从发展中国家和冲突地区转运过来增加了更多复杂性。广泛的损伤、转运延迟和复杂的微生物学共同带来了独特的挑战。
进行一项回顾性研究，以分析2011年1月至2016年1月期间从海外转至我们机构（帝国理工学院国民保健服务信托基金）的开放性四肢骨折患者的手术和微生物学情况。
20名平民患者的21处开放性四肢骨折从11个不同国家转诊至我们科室。所有患者在初始监测培养时均有多种微生物伤口污染。5名患者（25%）根据骨损伤程度接受了截肢手术；监测培养结果为阳性并不妨碍肢体重建，7名患者接受了复杂重建，8名患者接受了简单重建以实现伤口覆盖。100%的患者出院时骨折愈合且无感染。
从海外转诊来的开放性四肢骨折患者除了有广泛的创伤伤口外，还面临多种微生物感染这一独特挑战。尽管组织培养的微生物学结果为阳性，但通过充分的抗菌治疗仍可取得良好预后。保肢决策和所采用重建的复杂性应基于实现有意义功能恢复的可能性，这主要由骨损伤程度决定。重建的复杂性基于保肢后预测的长期功能。
