Management of severe lower limb injuries: a 4-year experience with a revisited recent approach at Zagazig University Hospital, Plastic Surgery Department

Background
Management of complex open fractures of the lower extremities needs a special multidisciplinary team in major trauma centers. Limb salvage is attempted in appropriately selected patients via joint orthopedic and plastic surgery care. Recent guidance shows strong evidence of better long-term functional outcomes and decrease of complications when coordinated combined orthoplastic approach can be successfully delivered.
Patients and methods
A total of 52 patients were included in this retrospective comparative study of the outcomes from two approaches, managed either by single-team approach, plastic or orthopedic (group A), or by orthoplastic setting (group B), in Zagazig University Hospitals between August 2016 and July 2020. All data were collected from the patient records. Follow-up outcomes involved fracture union, weight bearing, persistent deep infection, and secondary amputations.
Results
The most encountered injury pattern in both groups was Gustilo IIIb. The majority of those injuries were sustained owing to road traffic accidents in both groups. The mean bone loss was 2.05±2.3 cm in group A and 2.06±2.2 cm in group B. There was a statistically significant difference between the mean time to initial debridement, where in group B, it was 8±2.04 h, whereas in group A, it was 10.7±4.2 h (=0.05). The time to definitive fixation showed a highly significant difference from 9.8±2.9 weeks in group A to 4.4±0.8 weeks in group B. The relative risk for flap loss showed significant reduction in group B (=0.021).
Conclusion
Overall outcomes showed obvious improvement with less complication rate of the combined orthoplastic approach over the previous single-team speciality. Nonetheless, certain complications like nonunion and need for secondary amputation did not show quite a significant difference, which may indicate that our early experience with orthoplastic approach for the management of open tibia fracture is in need for further audit and refinements to take place.