Perioperative management in traumatic soft tissue defects with revascularized flaps

doi:10.3969/j.issn.2095-4344.2014.42.021

Abstract

Abstract:

BACKGROUND: Traumatic soft tissue defects of the limbs are usually accompanied with the exposure of tendon, joint capsule, bone or internal fixator, which can be reconstructed by skin flap. Previous research has shown that it is an important method to repair traumatic tissue defects with flaps. However, rarely research reports perioperative management about flap bed so far.
OBJECTIVE: To explore the perioperative strategy for repairing traumatic soft tissue defects with revascularized flaps.
METHODS: Totally 94 cases undergoing secondary skin flap repair were enrolled. Intraoperative debridement using tourniquet was performed, and the wound was washed with mass of physiological saline. Whether the tissues, including bone, tendon, joint capsule and internal fixator, were reserved or not depended on their viability, and then the flaps were harvested to repair defects, and drainage was placed properly at last.
RESULTS AND CONCLUSION: The flaps survived in all cases. Exudation occurred in 5 cases with the exposure of bone, and 28 cases with the exposure of tendon or joint capsule healed normally. No complications were associated with the reservation of the internal fixators, but delayed-union occurred in three cases and nonunion in one case. These findings indicate that the perioperative treatment of the application of skin flap is worthy of attention. Careful debridement, advisable choice of the flap, efficient drainage and using antibiotic normatively are all keys. Treatment of the bone, tendon, joint capsule and internal fixator which are exposed should not only weigh the advantage and disadvantage, but also relax the indication of reserving them.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

全文链接：

Key words: Surgical flaps, perioperative care, soft tissue injuries, joint capsule

CLC Number:

R318

Zhang Gui-chun, Cao Xue-cheng, Zheng Jin-long. Perioperative management in traumatic soft tissue defects with revascularized flaps[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(42): 6832-6837.

Figures/Tables 1

Quantitative analysis of participants All flaps survived with no withdrawal. Effect of flap repair on traumatic soft tissue defects All flaps survived, there were no deep infections. Five flaps had minor tissue loss requiring subsequent small skin grafts, all of which healed. In these 94 cases, we had 5 cases of superficial necrosis of the flaps which healed with supportive therapy. There were no cases of complete necrosis. There were no donor site complications and no interference of muscle function at the donor sites. Of the operated cases, the results were excellent in almost all cases, but three cases required tenolysis which consisted of surgical release of tendon adhesions. For cases with joint capsule injuries, all Kirschner wires were removed after 6 weeks. Four cases of post-traumatic delayed and non-union (three of delayed union and one of non-union) were treated with musculo-periosteo-osteal decortication and autogenous cancellous bone grafts and finally healed. Typical cases Case 1: A 43-year-old woman was injured in traffic accident (open tibia fibula comminuted fracture, Gustilo III). The fracture was debrided and fixed with anatomically shaped plate, avascular necrosis developed, the vascular host bed and inserted plate were exposed during the debridement process. The patient was referred to our hospital 6 weeks later. The fracture was irrigated and debrided without anesthesia, closed suction drainage system was used to drain fluids, and the wound was covered with a surgical dressing for 2 weeks. Small fragments of loose bone were excised and discarded, and the musculocutaneous sural artery flap was used to cover the fracture. A small-diameter suction drain tube was inserted beneath the flap, and plates were maintained during healing (Figures 1-3). The bone defects were attempted to be reconstructed at second stage surgery. Case 2: A 35-year-old man presented with comminution of second and third metacarpals after a crush injury. The comminuted fracture was treated with open reduction and internal fixation in local hospital, and developed nonunion and avascular necrosis. The patient was referred to our hospital 2 weeks later. After the debridement of necrotic tissue in the sacral ulcer, the skin and soft tissue defects were reconstructed with a retrograde posterior interosseous artery flap. The flap was sutured, and the flap survived completely with extensor tendons and steels (Figure 4)."

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