DOS Kongressen 2014 ·
243
Impact of timing of soft tissue coverage and
antibiotics in outcome of open tibial 2 fractures
Ulrik Kähler Olesen, Rasmus Juul, Christian Bonde, Claus Moser, Henrik Eckardt
Ortopædkirurgisk Klinik U, Rigshospitalet; Ortopædkirurgisk afdeling ,
Slagelse Hospital; Plastikkirurgisk klinik, Rigshospitalet; MIkrobiologisk afdel-
ing, Rigshospitalet; Department of Traumatology, University Hospital Basel,
Switzerland
Background:
Treatment of open fractures is complex and somewhat contro-
versial. The purpose of the present study is to add evidence to the management
of open injuries to the lower extremity, where tissue loss necessitates using a
free flap.
Purpose / Aim of Study:
We identify factors for a successful outcome:
Avoidance of amputation and infection, achievement of union of the fracture
and obtaining tissue coverage over the bone. Our study also evaluates the mi-
crobiology of open fractures and suggests the choice of antibiotic prophylaxis
for this serious condition
Materials and Methods:
From January 2002 to June 2013 we treated 56
patients with an open tibial fracture requiring coverage with a free flap. We
reviewed patient records and databases for information on time to coverage,
infection, microbiology, amputations, and union of the fracture. Follow-up was
minimum one year
Findings / Results:
In 45 patients, data was complete. When soft tissue cov-
erage was delayed beyond 7 days, infection rate increased from 27% to 60%.
High-energy trauma patients had a higher risk of amputation, infection, flap
failure and non-union. Smokers had a higher risk of flap failure and non-union.
Most organisms found in the infected wounds of open fractures were resistant
to cefuroxime, aminoglycosides and amoxicillin, but sensitive to vancomycin and
meropenem.
Conclusions:
To our knowledge, our study is unique in its combination of data
on timing and microbiology. We conclude that flap coverage within one week
remains essential for successful outcome. We suggest antibiotic prophylax-
is treatment with vancomycin and meropenem until the wound is covered, in
these rare injuries
190.
