Abstract
Background: Soft-tissue complications often dictate the success of limb salvage and the overall outcome of open fractures. Based on prior work at the R Adams Cowley Shock Trauma Center, the authors hypothesize that wounds larger than 200 cm2 are associated with a greater likelihood of both flap-related reoperation and wound complications among patients requiring soft-tissue reconstruction with a rotational flap or free tissue transfer. Methods: This study was a secondary analysis of Fluid Lavage in Open Wounds trial data that included all patients who received a rotational or free tissue flap transfer for an open fracture. The primary outcome was flap-related reoperation within 12 months of injury. The secondary outcome was wound complication, which included events treated operatively or nonoperatively. Multivariable logistic regression was used to assess the association between wound size and outcomes, adjusting for confounders. Results: Seventeen percent of the 112 patients required a flap-related reoperation. A wound size greater than 200 cm2 was not associated with reoperation in an unadjusted model (p = 0.64) or adjusting for Gustilo type (p = 0.70). The sample had an overall wound complication rate of 47.3 percent. Patients with a wound size of greater than 200 cm2 were three times more likely to experience wound complications (OR, 3.05; 95 percent CI, 1.08 to 8.62; p = 0.04) when adjusting for moderate to severe wound contamination and wound closure in the operating room. Conclusion: The findings of this study demonstrate that wound surface area is an integral determinant for wound complication following soft-tissue flap treatment, but found no association between wound surface area and flap-related reoperation rates.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 228-236 |
| Number of pages | 9 |
| Journal | Plastic and reconstructive surgery |
| Volume | 142 |
| Issue number | 1 |
| DOIs | |
| State | Published - 2018 |
| Externally published | Yes |
ASJC Scopus subject areas
- Surgery
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In: Plastic and reconstructive surgery, Vol. 142, No. 1, 2018, p. 228-236.
Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Wound surface area as a risk factor for flap complications among patients with open fractures
AU - Shea, Phelan
AU - O'Hara, Nathan N.
AU - Sprague, Sheila A.
AU - Bhandari, Mohit
AU - Petrisor, Brad A.
AU - Jeray, Kyle J.
AU - Zhan, Min
AU - Slobogean, Gerard P.
AU - Pensy, Raymond A.
AU - Guyatt, Gordon H.
AU - Walter, Stephen D.
AU - Schemitsch, Emil H.
AU - Tornetta, Paul
AU - Anglen, Jeff
AU - Bosse, Michael
AU - Liew, Susan
AU - Sancheti, Parag
AU - McKay, Paula
AU - Madden, Kim
AU - Tai, Kerry
AU - Heels-Ansdell, Diane
AU - Buckingham, Lisa
AU - Duraikannan, Aravin
AU - Tanner, Stephanie L.
AU - Snider, Rebecca G.
AU - Altman, Douglas
AU - Gandhi, Rajiv
AU - Bischoff, Markus
AU - Rocca, Gregory J.Della
AU - Ristevski, Bill
AU - Rajaratnam, Krishan
AU - Williams, Dale
AU - Denkers, Matthew
AU - Bednar, Drew
AU - Sadler, John
AU - Kwok, Desmond
AU - Drew, Brian
AU - Wong, Ivan
AU - Hall, Jeremy A.
AU - McKee, Michael D.
AU - Ahn, Henry
AU - Whelan, Daniel
AU - Waddell, James
AU - Daniels, Timothy
AU - Bogoch, Earl
AU - Nauth, Aaron
AU - Vicente, Milena R.
AU - Hidy, Jennifer T.
AU - Sanders, David
AU - Lawendy, Abdel Rahman
AU - Gurr, Kevin
AU - Carey, Timothy
AU - Bailey, Chris
AU - Macleod, Mark
AU - Bartley, Debra
AU - Tieszer, Christina
AU - Coles, Chad
AU - Leighton, Ross
AU - Richardson, C. Glen
AU - Biddulph, Michael
AU - Gross, Michael
AU - Dunbar, Michael
AU - Amirault, J. David
AU - Alexander, David
AU - Coady, Catherine
AU - Glazebrook, Mark
AU - Johnston, David
AU - Oxner, William
AU - Trenholm, J. Andrew
AU - Reardon, Gerald
AU - Trask, Kelly
AU - MacDonald, Shelley
AU - Papp, Steven
AU - Gofton, Wade
AU - Kingwell, Stephen
AU - O'Neill, Joseph
AU - Johnson, Garth
AU - Wai, Eugene
AU - Foxall, Julia
AU - Broekhuyse, Henry M.
AU - O'Brien, Peter J.
AU - Blachut, Piotr A.
AU - Lefaivre, Kelly A.
AU - Johal, Raman
AU - Leduc, Stéphane
AU - Laflamme, G. Yves
AU - Beaumont, Pierre
AU - Malo, Michel
AU - Benoit, Benoit
AU - Rouleau, Dominique
AU - Ranger, Pierre
AU - Fournier, Julie
AU - Tardif, Karine
AU - Reindl, Rudy
AU - Berry, Greg
AU - Harvey, Edward
AU - Fisher, William
AU - Burman, Mark
AU - Martineau, Paul
AU - Lenczner, Eric
AU - Marien, Robert
AU - Turcotte, Robert
AU - Tanzer, Michael
AU - Talbot, Max
AU - Jarzem, Peter
AU - Weber, Mike
AU - Houghton, Fiona
AU - McCormack, Robert
AU - Apostle, Kelly
AU - Boyer, Dory
AU - Moola, Farhad
AU - Perey, Bertrand
AU - Stone, Trevor
AU - Viskontas, Darius
AU - Lemke, H. Michael
AU - Zomar, Mauri
AU - Moon, Karyn
AU - Moon, Raely
AU - Kreder, Hans
AU - Jenkinson, Richard
AU - Stephen, David
AU - Nousiainen, Markku
AU - Axelrod, Terry
AU - Wadey, Veronica
AU - Ford, Michael
AU - Finkelstein, Joel
AU - Holtby, Richard
AU - Richards, Robin
AU - Rodriguez-Elizalde, Sebastian
AU - Nam, Diane
AU - Yee, Albert
AU - Henry, Patrick
AU - Murnaghan, John
AU - Malempati, Harsha
AU - Sernik, Julian
AU - Dwyer, Tim
AU - Milner, Katrine
AU - Kunz, Monica
AU - MacNevin, Melanie
AU - Ghent, Wesley
AU - Adamsahib, Fathima
AU - De Gorter, Ria
AU - Arakgi, Michelle
AU - Tufescu, Ted V.
AU - Pilkey, Brad
AU - Graham, Chris
AU - Barron, Laurie
AU - Hammond, Allan
AU - Sultana, Nigar
AU - Bicknell, Ryan T.
AU - Pichora, David
AU - Campbell, Aaron
AU - Howells, Fiona
AU - Deshaies, Annie
AU - Balg, Frédéric
AU - Cabana, François
AU - Dumais, Rejean
AU - Joncas, Jean François
AU - Magalhaes-Grave, Marc André
AU - Patenaude, Nicolas
AU - LaRue, Bernard
AU - Ricard, Stéphane
AU - Théorêt, Chantal
AU - Vézina, François
AU - Svotelis, Amy
AU - Downey, Jennifer
AU - Pelet, Stéphane
AU - Lamontagne, Jean
AU - Bédard, Luc
AU - Denault, Alexandre
AU - Lavallée, Pierre
AU - Petitclerc, Luc
AU - Laliberté, Bernard
AU - Bédard, Martin
AU - Roger, Marie Eve
AU - Lemire, Luc
AU - Côté, Hélène
AU - Lépine, Linda
AU - Lévesque-Bernier, Pascale
AU - Broderick, J. Scott
AU - Goetz, David R.
AU - Schaller, Thomas M.
AU - Porter, Scott E.
AU - Beckish, Michael L.
AU - Adams, John D.
AU - Barden, Benjamin B.
AU - Bennett, Grant W.
AU - Conner, David M.
AU - Creek, Aaron T.
AU - Earles, Melissa M.
AU - Finley, Stephen H.
AU - Foret, Jonathan L.
AU - Gudger, Garland K.
AU - Gurich, Richard W.
AU - Hill, Austin D.
AU - Hollenbeck, S. Matthew
AU - Jackson, Lyle T.
AU - Koch, Benjamin S.
AU - Kruse, Kevin K.
AU - Lackey, Wesley G.
AU - Langan, Justin W.
AU - Lee, Julia
AU - Leffler, Lauren C.
AU - Maughon, Michael J.
AU - McClure, S. Brennan
AU - Miller, Timothy J.
AU - Murphy, R. Lee
AU - O'Malley, Lawrence K.
AU - Price, Dustin M.
AU - Sharp, Lorra M.
AU - Smitherman, J. Adam
AU - Tanksley, John A.
AU - Torres, Erick G.
AU - Watson, Dylan J.
AU - Watson, Scott T.
AU - Bielby, Shea A.
AU - Nastoff, Lauren A.
AU - Teasdall, Robert J.
AU - Hsu, Joseph
AU - Bedigrew, Katherine M.
AU - Gerlinger, Tod
AU - Brown, Dave
AU - Alderete, Joseph
AU - Kirk, Kevin
AU - Cho, Mickey
AU - Johnson, Anthony
AU - Topp, Raymond
AU - Rispoli, Damian
AU - Ficke, James
AU - Ritchie, Eric
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AU - Sayeed, Siraj
AU - Charlton, Michael
AU - Walick, Kristen
AU - Tuder, Dmitry
AU - Maytok, Greg
AU - Burns, Travis
AU - Gajewski, Donald
AU - Kactmas, Warren
AU - Andreson, Ramnov
AU - Osborn, Patrick
AU - Connally, Michael
AU - Lopez, Donna
AU - Fan, Mary
AU - Mann, Dennis
AU - Garza, Andrea
AU - Harman, Rina L.
AU - Olson, Steven
AU - Zura, Robert
AU - Reilly, Rachel
AU - Patel, Prerana
AU - Moorman, Claude T.
AU - Leversedge, Fraser
AU - Harbour, Chard
AU - Brigman, Brian
AU - Ruch, David
AU - Leontaritis, Nikoletta
AU - Bolognesi, Michael
AU - Ramasunder, Shalini
AU - Toth, Alison
AU - Diane, Allen
AU - Garrigues, Grant
AU - Taylor, Dean
AU - Mather, Richard C.
AU - Reid, Kristoff
AU - Lark, Robert
AU - Adams, Samuel
AU - Manson, Maria
AU - Kandemir, Utku
AU - Morshed, Saam
AU - Pekmezci, Murat
AU - Coughlin, Richard
AU - McClellan, Trigg
AU - Marmor, Meir
AU - Meinberg, Eric
AU - Belaye, Tigist
AU - Kwong, Jonathan
AU - Jones, Clifford B.
AU - Ringler, James R.
AU - Endres, Terrence J.
AU - Bielema, David J.
AU - Jabara, Michael R.
AU - Agnew, Samuel G.
AU - Sietsema, Debra L.
AU - Walker, Jane E.
AU - Della Rocca, Gregory J.
AU - Crist, Brett D.
AU - Murtha, Yvonne M.
AU - Volgas, David A.
AU - Stannard, James P.
AU - Anderson, Linda K.
AU - Sullivan, Kelly M.
AU - Clark, Lori Kramer
AU - Markley, Kathleen
AU - Clawson, Stacee
AU - Schmidt, Andrew
AU - Yoon, Patrick
AU - Varecka, Thomas
AU - Karam, Matthew
AU - Westberg, Jerald R.
AU - Cannada, Lisa K.
AU - Stoneback, Jason
AU - Kuhn, Kevin
AU - Nott, Erik
AU - Dillender, Leslie
AU - Shively, Karl
AU - Mullis, Brian
AU - Ertl, Janos
AU - Worman, Ripley
AU - Anglen, Jeffrey
AU - Frizzell, Valda
AU - Moore, Molly
AU - Prayson, Michael J.
AU - Nelles, David
AU - Vourazeris, Jason
AU - Ross, Matthew
AU - Laughlin, Richard T.
AU - Cox, Joseph
AU - Trimba, Roman
AU - Bradford-Johnson, Joy M.
AU - Marcantonio, Andrew J.
AU - Kain, Michael
AU - Wilk, Richard
AU - Lemos, Mark
AU - Baumfeld, Joshua
AU - Tilzey, John
AU - Jolley, Brian
AU - Garfi, John
AU - Tarkin, Ivan
AU - Evans, Andrew
AU - Siska, Peter
AU - Blackrick, Lisa
AU - Farrell, Dana J.
AU - Keener, Emily
AU - Lowe, Jason
AU - Min, William
AU - Leary, Jeffrey
AU - Stewart, Rena
AU - Barnes, Leslie
AU - Shadmi, Nurit
AU - Robinson, Matthew
AU - Vlack, Taylor
AU - Hornbuckle, Kathryn
AU - Leonard, Melanese
AU - Malone, Nikia Hawkins
AU - Nix, Tanya
AU - Goldstein, Jessica
AU - Zamorano, David
AU - Tynan, Martin
AU - Bederman, Samuel
AU - Bhatia, Nitin
AU - Kreitenberg, Arthur
AU - Hoang, Bang
AU - Pourmand, Deeba
AU - Lawson, Deanna
AU - Rhorer, Anthony
AU - Miller, Brian
AU - Ortega, Gilbert
AU - Wood, Lori
AU - Place, Veronica
AU - Bedi, Harvinder
AU - Carr, Ashley
AU - Chia, Andrew
AU - Curry, Hamish
AU - Csongvay, Steve
AU - Donohue, Craig
AU - Doig, Stephen
AU - Edwards, Elton
AU - Ek, Eugene
AU - Esser, Max
AU - Etherington, Greg
AU - Freeman, Richard
AU - Gong, Andrew
AU - Li, Doug
AU - Mammen, Matthan
AU - Miller, Russell
AU - Moaveni, Ash
AU - Russ, Mathias
AU - Ton, Lu
AU - Treseder, Tom
AU - Wang, Otis
AU - Murdoch, Zoe
AU - Sage, Claire
AU - Dowrick, Adam
AU - Clarke-Jenssen, John
AU - Frihagen, Frede
AU - Nordsletten, Lars
AU - Nicolaysen, Tor
AU - Apold, Hilde
AU - Iversen, Petter
AU - Stodle, Are
AU - Andersen, Mette
AU - Halvorsen, Vera
AU - Hjorthaug, Geir
AU - Lippert, Anders
AU - Sletten, Ida
AU - Langslet, Ellen
AU - Molund, Marius
AU - Amundsen, Asgeir
AU - Muller, Oliver
AU - Aga, Cathrine
AU - Ianssen, Torben
AU - Flugsrud, Gunnar
AU - Rydinge, Jonas
AU - Hemlock, Kim
AU - Brattgjerd, Jan Egil
AU - Hoseth, John Magne
AU - Flatoy, Bernhard
AU - Furunes, Havard
AU - Bogsti, Peder
AU - Ekås, Guri
AU - Moatshe, Gilbert
AU - Al-Ashtari, Ali
AU - Fjalestad, Tore
AU - Nilsen, Fredrik
AU - Smedsrud, Morten
AU - Brekke, Anne Christine
AU - Vesterhus, Elise Berg
AU - Knuts, Sissel
AU - Rocha, Steve
AU - Puram, Chetan
AU - Patil, Atul
AU - Jhangiani, Neelam
AU - Rai, Anil K.
AU - Rai, Kamal Narayan
AU - Jabade, Vivek V.
AU - Nassikars, Deepali
AU - Karne, Narayan J.
AU - Metha, Chetan
AU - Shankar, A. Navaladi
AU - Navaladi Shankar, A.
AU - Saravana, R.
AU - Gupta, Ajay
AU - Jain, Neeraj
AU - Bhatia, Mahesh
AU - Arora, Vinod
AU - Tyagi, Vivek
AU - Dubey, Anoop
AU - Yadav, Vinit
AU - Rai, Rani
AU - Doshi, Kiran M.
AU - Patil, Arjun
N1 - Funding Information: The study was funded by the Canadian Institutes of Health Research (MCT-93173), the U.S. Army Institute of Surgical Research Orthopedic Trauma Research Program (W81XWH-08-1-0473), the U.S. Army Institute of Surgical Research Peer Reviewed Orthopedic Research Program (W81XWH-12-1-0530), and the Association Internationale pour l’Ostéosynthèse Dynamique. Publisher Copyright: Copyright © 2018 by the American Society of Plastic Surgeons.
PY - 2018
Y1 - 2018
N2 - Background: Soft-tissue complications often dictate the success of limb salvage and the overall outcome of open fractures. Based on prior work at the R Adams Cowley Shock Trauma Center, the authors hypothesize that wounds larger than 200 cm2 are associated with a greater likelihood of both flap-related reoperation and wound complications among patients requiring soft-tissue reconstruction with a rotational flap or free tissue transfer. Methods: This study was a secondary analysis of Fluid Lavage in Open Wounds trial data that included all patients who received a rotational or free tissue flap transfer for an open fracture. The primary outcome was flap-related reoperation within 12 months of injury. The secondary outcome was wound complication, which included events treated operatively or nonoperatively. Multivariable logistic regression was used to assess the association between wound size and outcomes, adjusting for confounders. Results: Seventeen percent of the 112 patients required a flap-related reoperation. A wound size greater than 200 cm2 was not associated with reoperation in an unadjusted model (p = 0.64) or adjusting for Gustilo type (p = 0.70). The sample had an overall wound complication rate of 47.3 percent. Patients with a wound size of greater than 200 cm2 were three times more likely to experience wound complications (OR, 3.05; 95 percent CI, 1.08 to 8.62; p = 0.04) when adjusting for moderate to severe wound contamination and wound closure in the operating room. Conclusion: The findings of this study demonstrate that wound surface area is an integral determinant for wound complication following soft-tissue flap treatment, but found no association between wound surface area and flap-related reoperation rates.
AB - Background: Soft-tissue complications often dictate the success of limb salvage and the overall outcome of open fractures. Based on prior work at the R Adams Cowley Shock Trauma Center, the authors hypothesize that wounds larger than 200 cm2 are associated with a greater likelihood of both flap-related reoperation and wound complications among patients requiring soft-tissue reconstruction with a rotational flap or free tissue transfer. Methods: This study was a secondary analysis of Fluid Lavage in Open Wounds trial data that included all patients who received a rotational or free tissue flap transfer for an open fracture. The primary outcome was flap-related reoperation within 12 months of injury. The secondary outcome was wound complication, which included events treated operatively or nonoperatively. Multivariable logistic regression was used to assess the association between wound size and outcomes, adjusting for confounders. Results: Seventeen percent of the 112 patients required a flap-related reoperation. A wound size greater than 200 cm2 was not associated with reoperation in an unadjusted model (p = 0.64) or adjusting for Gustilo type (p = 0.70). The sample had an overall wound complication rate of 47.3 percent. Patients with a wound size of greater than 200 cm2 were three times more likely to experience wound complications (OR, 3.05; 95 percent CI, 1.08 to 8.62; p = 0.04) when adjusting for moderate to severe wound contamination and wound closure in the operating room. Conclusion: The findings of this study demonstrate that wound surface area is an integral determinant for wound complication following soft-tissue flap treatment, but found no association between wound surface area and flap-related reoperation rates.
UR - http://www.scopus.com/inward/record.url?scp=85056942077&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85056942077&partnerID=8YFLogxK
U2 - 10.1097/PRS.0000000000004418
DO - 10.1097/PRS.0000000000004418
M3 - Article
C2 - 29608532
AN - SCOPUS:85056942077
SN - 0032-1052
VL - 142
SP - 228
EP - 236
JO - Plastic and reconstructive surgery
JF - Plastic and reconstructive surgery
IS - 1
ER -