Abstract
Background
Injury to the lower extremity is one of the most common traumatic injuries encountered in both combat and civilian situations. Improvements in sterile technique, the use of antibiotics, bony fixation, and microvascular reconstruction have shifted the management paradigm from predominantly amputation to limb salvage. We reviewed acute lower-extremity reconstruction in a single suburban trauma center and identified common characteristics of functional and adverse outcomes.
Methods
The records of patients treated at a level I trauma center for lower-extremity injuries and requiring plastic surgery consultation or intervention were reviewed. Common demographic and clinical characteristics for three functional outcomes (range of motion, return to work, and ambulation) and three adverse outcomes (venous thromboembolism, rehospitalization, and operative revision) were compared.
Results
Of the 4039 patients treated for a lower-extremity traumatic injury over a 6-year period, 92 (2.3%) patients met the inclusion criteria. Severity of injury was a common determinant of outcome. On long-term follow-up, the majority of patients were ambulatory (n = 50), albeit frequently with some deficit in range of motion or gait disturbance. When modifiable characteristics were evaluated, an increased length of time to soft-tissue coverage was associated with both an increased incidence of venous thromboembolism and range-of-motion deficit.
Conclusions
Delayed definitive soft-tissue coverage of lower-extremity traumatic wounds is associated with thromboembolic events and range-of-motion deficits. Involvement of a plastic surgeon in a multi-disciplinary trauma team could expedite definitive wound coverage and improve clinical outcomes of lower-extremity trauma. Future research evaluating the impact of early plastic surgery involvement on outcome measures is necessary.
Level of Evidence: Level IV, risk/prognostic study
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