Zamorano Álvaro I, Vaccia Matías A, Albarrán Carlos F, Parra Rodrigo I, Turner Tomás, Rivera Ignacio A, Errázuriz Tomás, Oyarzún Andrés S A, Garrido Osvaldo A, Suárez Pablo F, Zecchetto Pierluca, Bahamonde Luis A
Lower Extremities Trauma Unit, Department of Orthopaedics and Traumatology, Hospital Clínico Mutual de Seguridad, Alameda 4848, Estación Central, Santiago, Chile.
Department of Orthopaedics and Traumatology, Hospital Clínico Universidad de Chile Orthopedic Surgery Service, Santiago, Chile.
Eur J Orthop Surg Traumatol. 2025 Mar 18;35(1):121. doi: 10.1007/s00590-025-04225-4.
Open tibia fractures that require a soft tissue flap for adequate coverage (Gustilo- Anderson IIIB) are a significant challenge for trauma units. The incidence of fracture-related infection (FRI) has been reported to range between 10% and 52%. Early antibiotic therapy, followed by surgical debridement and early soft tissue coverage, is considered a safe and effective treatment. Typically, the gold standard is the "fix and flap" approach. However, local circumstances can impact the feasibility of early flap coverage. This study aims to determine whether there is a safe window for soft tissue coverage when an immediate ortho-plastic approach is not available.
In this retrospective analysis of a prospective cohort of 803 patients who sustained a tibia fracture and were treated in a level I trauma centre in a developing country, we describe a local protocol of management. Of all the patients, 61 met the inclusion criteria and were followed for at least 12 months after flap coverage. The primary outcome was the development of FRI.
Patients who underwent flap surgery within 8 days of the fracture, following the local protocol, had a 12.5% infection rate.
Utilizing a standardized management protocol followed by soft tissue flap coverage performed within 8 days is safe and effective in reducing the risk of developing FRI in open tibia fractures GA IIIB.
对于创伤科室而言，需要软组织瓣进行充分覆盖的开放性胫骨骨折（ Gustilo-Anderson IIIB型）是一项重大挑战。据报道，骨折相关感染（FRI）的发生率在10%至52%之间。早期抗生素治疗，随后进行手术清创和早期软组织覆盖，被认为是一种安全有效的治疗方法。通常，金标准是“固定并植皮瓣”方法。然而，当地情况可能会影响早期植皮瓣覆盖的可行性。本研究旨在确定在无法采用即时骨科整形方法时，软组织覆盖是否存在安全窗口期。
在对一个前瞻性队列中的803例胫骨骨折患者进行的回顾性分析中，这些患者在一个发展中国家的一级创伤中心接受治疗，我们描述了一种当地的管理方案。在所有患者中，61例符合纳入标准，并在皮瓣覆盖后至少随访12个月。主要结局是发生FRI。
按照当地方案在骨折后8天内接受皮瓣手术的患者，感染率为12.5%。
采用标准化管理方案，随后在8天内进行软组织皮瓣覆盖，对于降低开放性胫骨骨折GA IIIB型发生FRI的风险是安全有效的。
