Department of Orthopaedic Surgery, Myongji Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea.
Department of Plastic and Reconstructive Surgery, School of Medicine, Ewha Womans University, Seoul, Republic of Korea.
J Reconstr Microsurg. 2021 Mar;37(3):249-255. doi: 10.1055/s-0040-1717151. Epub 2020 Oct 14.
The timing of soft tissue reconstruction for soft-tissue defect in patients with open fractures in the lower extremity is known to be critical for successful outcomes. However, medical advances, including development of dressing materials and refinement in the microsurgical techniques, might have undergone modifications in this "critical period." There have been no studies on the role of timing on reconstructive outcomes. Thus, we have analyzed the effect of reconstruction timing on optimal surgical outcomes and complication rates in a single type of lower extremity injury.
Data of patients who underwent microvascular free tissue transfer with an open fracture in the lower extremity from 2014 through 2016 were retrospectively reviewed ( = 103). Surgical outcomes, including flap complication rate, flap revision rate, and long-term bony complications, were analyzed serially in accordance with time interval until coverage using the receiver operating characteristic (ROC) curve analysis. Significant factors with a < 0.05 in the univariate analysis were included in the multivariate logistic regression model to identify independent risk factors.
A total of 46 patients (33 males and 13 females) were finally included in the study. Based on the association between surgical timing and flap-related complication rate, the best cutoff period for surgery was 33 days, with an area under the curve of 0.658 ( = 0.040). Further, in the revision rate, the cutoff period was identified as 10 days ( = 0.016). Regarding the incidence of bony complications, ROC curve showed that the maximal period until operation was 91 days with no influence on the occurrence of bony complications ( = 0.029).
Although the best method is an early reconstruction, many modalities such as negative pressure wound therapy play a role as a temporary measure. Our study suggests that the acute or early period for successful reconstruction might be extended compared with previous studies.
众所周知，下肢开放性骨折患者软组织缺损的软组织重建时机对于获得良好的治疗效果至关重要。然而，包括敷料材料的发展和显微外科技术的改进等医学进步可能已经改变了这个“关键时期”。目前还没有研究探讨时机对重建效果的影响。因此，我们分析了单一类型下肢损伤重建时机对最佳手术效果和并发症发生率的影响。
回顾性分析了 2014 年至 2016 年间接受下肢开放性骨折伴显微血管游离组织转移的患者（共 103 例）的临床资料。根据应用接收者操作特征（ROC）曲线分析，按覆盖时间的间隔，连续分析手术结果，包括皮瓣并发症发生率、皮瓣修复率和长期骨并发症。单因素分析中 P 值<0.05 的有显著意义的因素纳入多因素逻辑回归模型，以确定独立的危险因素。
最终共有 46 例患者（33 名男性和 13 名女性）纳入本研究。根据手术时机与皮瓣相关并发症发生率之间的关系，手术的最佳时间间隔为 33 天，ROC 曲线下面积为 0.658（ P =0.040）。此外，在修复率方面，最佳时间间隔为 10 天（ P =0.016）。关于骨并发症的发生率，ROC 曲线显示，最长手术时间为 91 天，对骨并发症的发生没有影响（ P =0.029）。
尽管早期重建是最佳方法，但许多方法，如负压伤口治疗，都可以作为临时措施。本研究表明，与以往研究相比，成功重建的急性或早期时间可能会延长。
