Tiongco Rafael Felix P, Rezwan Siam K, Alahmadi Sami, Heron Matthew J, Sylvester Scott A, Seal Stella M, de Jong Tim, Elhelali Ala, Mundy Lily R
From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, DC.
Plast Reconstr Surg Glob Open. 2025 Jun 6;13(6):e6829. doi: 10.1097/GOX.0000000000006829. eCollection 2025 Jun.
Severe open lower extremity fractures often require soft tissue reconstruction with a flap. Infection is a common complication of lower extremity flap coverage and is associated with prolonged hospitalization, high costs, and poor patient-reported outcomes. Elapsed time from injury to flap coverage can increase infection risk, but the optimal timing threshold remains debatable. We aimed to synthesize the literature and determine if time to flap is associated with reduced infection rates following traumatic lower extremity injuries.
We searched 5 databases for articles published before March 2023. We included studies of 10 or more patients undergoing flap reconstruction for open lower extremity fractures. We extracted data on patient demographics, operative details, and postoperative complications and grouped individual data by time-to-flap: 72 hours or less versus more than 72 hours and 7 days or less versus more than 7 days. We performed meta-analyses at a significance level of α equal to 0.05.
Sixteen studies of 973 patients (986 extremities) were included. Reconstruction within 72 hours of injury was associated with a 52% reduction in infection (risk ratio [RR] 0.48 [95% confidence interval (CI) 0.25-0.89]) and a 41% reduction in all complications (RR 0.59 [95% CI 0.36-0.99]). Reconstruction within 7 days of injury was associated with a 50% reduction in infection (RR 0.50 [95% CI 0.31-0.82]) but no significant reduction in total complications (RR 0.57 [95% CI 0.28-1.15]).
Flap coverage within 72 hours of injury reduces infection risk in patients undergoing lower extremity reconstruction for open fractures.
严重的开放性下肢骨折通常需要使用皮瓣进行软组织重建。感染是下肢皮瓣覆盖术的常见并发症，与住院时间延长、费用高昂以及患者报告的不良预后相关。从受伤到皮瓣覆盖的时间间隔会增加感染风险，但最佳时间阈值仍存在争议。我们旨在综合文献，确定皮瓣植入时间与创伤性下肢损伤后感染率降低是否相关。
我们检索了5个数据库，查找2023年3月之前发表的文章。我们纳入了10例或更多接受开放性下肢骨折皮瓣重建的患者的研究。我们提取了患者人口统计学、手术细节和术后并发症的数据，并按皮瓣植入时间对个体数据进行分组：72小时及以内与超过72小时，以及7天及以内与超过7天。我们在显著性水平α等于0.05的情况下进行荟萃分析。
纳入了16项针对973例患者（986条肢体）的研究。受伤后72小时内进行重建与感染率降低52%（风险比[RR]0.48[95%置信区间(CI)0.25 - 0.89]）以及所有并发症减少41%（RR 0.59[95%CI 0.36 - 0.99]）相关。受伤后7天内进行重建与感染率降低50%（RR 0.50[95%CI 0.31 - 0.82]）相关，但总并发症无显著降低（RR 0.57[95%CI 0.28 - 1.15]）。
受伤后72小时内进行皮瓣覆盖可降低开放性骨折下肢重建患者的感染风险。
