J Reconstr Microsurg 2017; 33(S 01): S03-S07
DOI: 10.1055/s-0037-1603737
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Limb and Flap Salvage in Gustilo IIIC Injuries Treated by Vascular Repair and Emergency Free Flap Transfer

Zoran Marij Arnež
1  Department of Plastic and Reconstructive Surgery, Universita degli Studi di Trieste Dipartimento di Scienze Mediche Chirurgiche e della Salute, Trieste, Friuli-Venezia Giulia, Italy
,
Giovanni Papa
1  Department of Plastic and Reconstructive Surgery, Universita degli Studi di Trieste Dipartimento di Scienze Mediche Chirurgiche e della Salute, Trieste, Friuli-Venezia Giulia, Italy
,
Vittorio Ramella
1  Department of Plastic and Reconstructive Surgery, Universita degli Studi di Trieste Dipartimento di Scienze Mediche Chirurgiche e della Salute, Trieste, Friuli-Venezia Giulia, Italy
,
Federico Cesare Novati
1  Department of Plastic and Reconstructive Surgery, Universita degli Studi di Trieste Dipartimento di Scienze Mediche Chirurgiche e della Salute, Trieste, Friuli-Venezia Giulia, Italy
,
Uros Ahcan
2  Department of Plastic Surgery and Burns, Univerzitetni klinicny Center Ljubljana, Ljubljana, Slovenia
,
Chiara Stocco
1  Department of Plastic and Reconstructive Surgery, Universita degli Studi di Trieste Dipartimento di Scienze Mediche Chirurgiche e della Salute, Trieste, Friuli-Venezia Giulia, Italy
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Publikationsverlauf

26. Dezember 2016

29. April 2017

Publikationsdatum:
06. Oktober 2017 (online)

Abstract

Background Gustilo classification system defines IIIC fractures as open fractures associated with an arterial injury that requires repair. The aim of our study was to analyze the early outcome in terms of limb and flap salvage, early amputation, and early complication rate in patients with Gustilo IIIC open fractures treated in an emergency setup.

Methods We retrospectively reviewed 20 patients with Gustilo IIIC injuries treated by the “fix and flap” principle during the first surgical procedure in the first 24 hours after injury (emergency free flap transfer). All patients underwent surgery with radical debridement, wound irrigation, skeletal stabilization, vascular repair, and immediate free flap coverage.

Results In this study, 18 patients were men (90%) and 2 were women (10%). In all patients, a vascular repair was performed and in 17 cases (85%), the lower limb/foot was avascular and limb salvage was performed. Three patients had one vessels injured (15%) and 17 had two or three vessels injured (85%). In 9 out of 20 (45%), a revision surgery was needed for arterial (10%, 2 patients), arterial–venous (15%, 3 patients), and venous thrombosis (20%, 4 patients), while 4 patients required an early amputation (20%) and 1, a late one (5%). In three patients (15%), a flap loss occurred. Superficial infection occurred in seven cases (35%) and deep infection (osteomyelitis) in one (5%).

Conclusion A single-stage procedure performed in an emergency operating room could lead to an effective outcome with a high rate of limb salvage and satisfying long-term results.