Functional outcome of primary flap coverage and bony fixation of severe open fractures: A prospective observational study

Abstract

Introduction: Improved understanding of open fracture pathology, techniques of fracture fixation, soft-tissue care, and antimicrobial treatment has resulted in a significant reduction of morbidity and mortality associated with open fractures. Yet, the most severe open fracture types, even in the hands of experienced trauma surgeons, are still fraught with complications and impaired function. Major advances over the last century have moved the focus of management of such injuries beyond the preservation of life and limb to preservation of function and prevention of complications. In this series, we present a two year experience in the management of severe open fractures, Gustilo types IIIA and IIIB, with the use of free muscle flaps and overlying skin graft for their soft tissue reconstruction. Aim: The study was conducted to assess the functional outcome of severe open fractures treated by primary soft tissue/flap coverage and bony fixation. Materials and Methods: 35 patients with single segment (i.e thigh, leg, arm, forearm) injury were selected for the study and treated in a tertiary care hospital. Patients were evaluated clinically and radio graphically and those with type 3A and 3B Gustilo-Andersons injuries were selected and treated by thorough and radical debridement, bony fixation and soft-tissue coverage within 72 hours. Patients were followed up for a minimum period of 12 months. The post-operative complications, time taken for bony union, stability of scar, the range of movements of proximal and distal joints and the SMFA (Short Musculoskeletal Functional Assessment Questionnaire) were taken for the assessment of functional outcome. Results and Discussion: Results of SMFA were good in 20, fair in 9 and poor in 6 patients. Conclusion: This Fix and Flap protocol leads to a drastic reduction in infection rates and primary flap coverage has several other advantages both to patients and care givers in the form of reduction in length of hospital stay, cost of treatment, time spent in rehabilitation and most importantly the number of surgeries or debridements a patient must undergo. This method thus leads to a drastic reduction in physical, psychological, financial and social repercussions on the individual.