JPRAS OpenPub Date : 2024-09-11DOI: 10.1016/j.jpra.2024.09.002
I. Miguel-Escuredo, L.M. Cabañas-Weisz
{"title":"Anterior intercostal artery flap for implant salvation procedure in aesthetic breast surgery. Case report","authors":"I. Miguel-Escuredo, L.M. Cabañas-Weisz","doi":"10.1016/j.jpra.2024.09.002","DOIUrl":"10.1016/j.jpra.2024.09.002","url":null,"abstract":"<div><div>Implant exposure (IE) is a rare but devastating complication of aesthetic surgery owing to its psychological and economic implications for patients. In cases of IE, the most reliable strategy is implant removal; however, most patients do not prefer this option. In the absence of prosthetic contamination, salvage procedures are a viable option, with promising success rates.</div><div>Once IE is detected, the cutaneous defect cannot be treated with direct closure. If additional tissue is needed, the anterior intercostal artery perforator (AICAP) flap can be harvested, using the inframammary fold as a donor site, with minimal aesthetic implications. AICAP flaps can cover defects over the entire lower mammary pole and are useful as deep reinforcement for breast-slimmed flaps.</div><div>We report a case of augmentation mastopexy in a patient with grade I tuberous breasts. The undeveloped lower mammary pole led to delayed IE at 33 days after surgery. No signs of contamination were observed, and the cutaneous defect was covered with an AICAP flap. Antibiotic instillation was established for 24 h, and oral antibiotic therapy was administered for 3 weeks. Seven months later, a dog-ear deformity of the lateral inframammary fold and excess skin on the flap were excised, resulting in a good aesthetic outcome.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"42 ","pages":"Pages 186-190"},"PeriodicalIF":1.5,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JPRAS OpenPub Date : 2024-09-10DOI: 10.1016/j.jpra.2024.09.005
Leo Issagholian , Aldin Malkoc , Kendall A. Vignaroli , Melissa Miramontes , Cameron C. Neeki , Anthony Nguyen , Michael M. Neeki
{"title":"Lymphangiography and thoracic duct embolization for persistent chyle leak following augmentation mammoplasty and mastopexy","authors":"Leo Issagholian , Aldin Malkoc , Kendall A. Vignaroli , Melissa Miramontes , Cameron C. Neeki , Anthony Nguyen , Michael M. Neeki","doi":"10.1016/j.jpra.2024.09.005","DOIUrl":"10.1016/j.jpra.2024.09.005","url":null,"abstract":"<div><div>Chyle leak is a relatively rare post-operative complication of breast and axilla surgery, and the majority of these cases can be managed conservatively. We present the case of a 42-year-old female with chyle leak within the external thoracic cavity following elective augmentation mammoplasty and mastopexy. This patient failed initial operative management consisting of implant removal, washout, suture plication, and intra-operative drain placement as well as subsequent conservative management including diet modification, total parenteral nutrition, and percutaneous aspiration. Ultimately, this patientʼs chyle leak was successfully managed with lymphangiography and thoracic duct embolization. To our knowledge, this is the first documented case of successful use of lymphangiography with embolization to manage chyle leak within the superficial chest, and this intervention should be considered when contemplating management of this post-operative complication within the breast cavity.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"42 ","pages":"Pages 191-196"},"PeriodicalIF":1.5,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JPRAS OpenPub Date : 2024-09-07DOI: 10.1016/j.jpra.2024.08.005
Lei Zhang , Ye Pan , Jiagen Li , Hong Zhao
{"title":"Comparative evaluation of conventional and modified Hughes procedures in reconstructing large full-thickness defects of the lower eyelid","authors":"Lei Zhang , Ye Pan , Jiagen Li , Hong Zhao","doi":"10.1016/j.jpra.2024.08.005","DOIUrl":"10.1016/j.jpra.2024.08.005","url":null,"abstract":"<div><h3>Purpose</h3><p>To introduce a modified Hughes procedure for the repair of large full-thickness defects of the lower eyelid.</p></div><div><h3>Methods</h3><p>This retrospective study included 56 patients: 30 in the conventional group treated with a Hughes flap and 26 in the modified group treated with a full-thickness upper eyelid flap pedicled with levator aponeurosis, Muller muscle and conjunctiva. The reconstruction time, period of pedicle division and complication rates were evaluated.</p></div><div><h3>Results</h3><p>The lower eyelid reconstruction time was 89.2±7.7 minutes in the conventional group and 61.7±7.5 minutes in the modified group, whereas the period of pedicle division was 21.1±3.0 days in the conventional group and 10.8±3.0 days in the modified group, and the differences were statistically significant (p = 0.000 and 0.000). Lower eyelid retraction was 0.4±0.4 mm in the conventional group and 0.1±0.2 mm in the modified group, and the difference was statistically significant (p = 0.001).</p></div><div><h3>Conclusion</h3><p>The modified Hughes procedure in this study resulted in a shorter lower eyelid reconstruction time, a shorter period of pedicle division, and a lower degree of lower eyelid retraction. This technique is simple and convenient for reconstructing large full-thickness defects of the lower eyelid.</p></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"42 ","pages":"Pages 152-161"},"PeriodicalIF":1.5,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352587824001256/pdfft?md5=4c9c2498700801d669a831197eb2114e&pid=1-s2.0-S2352587824001256-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JPRAS OpenPub Date : 2024-09-06DOI: 10.1016/j.jpra.2024.08.008
Davide Talevi , Matteo Torresetti , Vania Recchi, Giovanni Di Benedetto
{"title":"Moving from the O-Z flap to the O-S flap for scalp reconstruction: A new geometrical model","authors":"Davide Talevi , Matteo Torresetti , Vania Recchi, Giovanni Di Benedetto","doi":"10.1016/j.jpra.2024.08.008","DOIUrl":"10.1016/j.jpra.2024.08.008","url":null,"abstract":"<div><div>The O-Z flap is the most commonly used local flap technique to repair round and oval scalp defects in clinical practice. Preoperative flap marking is one of the major technical issues of this reconstructive method and it is essential to achieve an optimal outcome. Nevertheless, the absence of a unified arc design scheme could significantly limit the use of this useful and reliable technique, and flap drawing is sometimes based more on the surgeon's experience than on a real geometrical model. Our aim was to describe an intuitive and standardizable method for O-Z flap marking, that we called “O-S flap,” based on a simple and easily replicable geometrical pattern.</div><div>We reported our experience in this case series of eight patients with skin tumors of the scalp who underwent scalp reconstruction with the “O-S flap” technique at our university hospital. Most patients had defects located on the vertex or parieto-occipital regions of the scalp. The area of the defects ranged from 7 to 78.5 cm<sup>2</sup>. There were no cases of flap necrosis, wound infection, or positive margins, and no patients required revision surgery.</div><div>We believe that our technical refinement represents a safe, easy, and reproducible method for O-Z flap marking. It follows a simple geometrical model which could be customized according to different clinical needs.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"42 ","pages":"Pages 178-185"},"PeriodicalIF":1.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JPRAS OpenPub Date : 2024-08-30DOI: 10.1016/j.jpra.2024.08.006
Amanda O'Halloran , Alan Walsh , Paul Harrington
{"title":"Stature seekers: Cosmetic limb lengthening in medical tourism a case report","authors":"Amanda O'Halloran , Alan Walsh , Paul Harrington","doi":"10.1016/j.jpra.2024.08.006","DOIUrl":"10.1016/j.jpra.2024.08.006","url":null,"abstract":"<div><p>This case report details orthopaedic cosmetic surgery tourism, an emerging trend where individuals seek orthopaedic cosmetic procedures abroad. While this practice is increasingly common, it lacks regulation, potentially endangering patients. Factors driving this trend include rising healthcare costs and lengthy waitlists in public healthcare systems. Patients often pursue surgery abroad to save costs, or access specialised procedures not available domestically.</p><p>However, complications can arise, necessitating costly management back home. Surgeons may face challenges due to unfamiliarity with overseas care, while patients encounter language barriers and variations in medical standards. This case report highlights a 28-year-old male who underwent bilateral limb lengthening surgery in Turkey, experiencing serious complications.</p><p>While existing data on cosmetic tourism mainly focuses on plastic and bariatric surgeries, documentation specific to orthopaedic cases is limited. This report underscores the need for further research and regulation in this rapidly growing field, to ensure patient safety and optimal outcomes.</p></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"42 ","pages":"Pages 146-151"},"PeriodicalIF":1.5,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352587824001281/pdfft?md5=49cf39e0af32b51d406347fe0e7fb442&pid=1-s2.0-S2352587824001281-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JPRAS OpenPub Date : 2024-08-23DOI: 10.1016/j.jpra.2024.08.004
Mario Faenza, Marcello Molle, Vincenzo Mazzarella, Andrea Maria Antonetti, Francesco Giuseppe Filosa, Tommaso Pelella, Giovanni Francesco Nicoletti
{"title":"Functional and Aesthetic Comparison between Grafts and Local Flaps in Non-Melanoma Skin Cancer Surgery of the Face: A Cohort Study","authors":"Mario Faenza, Marcello Molle, Vincenzo Mazzarella, Andrea Maria Antonetti, Francesco Giuseppe Filosa, Tommaso Pelella, Giovanni Francesco Nicoletti","doi":"10.1016/j.jpra.2024.08.004","DOIUrl":"10.1016/j.jpra.2024.08.004","url":null,"abstract":"<div><h3>Background</h3><p>Non-melanoma skin cancers represent more than 90 % of malignant skin tumors, with an incidence of 19.46 cases/100,000 people per year in Italy; however, their real incidence is underestimated. Although there are several therapeutic strategies, the only one that can guarantee a 95 % healing rate and the possibility of performing histological examination is surgical excision with subsequent reconstruction of the injured area with direct closure and with skin graft, local, regional, or free flaps in cases involving greater damage.</p></div><div><h3>Material and Methods</h3><p>Fifty-four patients underwent post-oncological head/face reconstructive surgery with skin graft or local flap between November 2021 and February 2023. The aesthetic outcomes (and the subsequent impact on the patients’ lives) were assessed using the Vancouver Scar Scale, Manchester Scar Scale, and Visual Analog Scale with scars ranked by three independent surgeon observers.</p></div><div><h3>Results</h3><p>Patients who received reconstruction with local flaps demonstrated improved aesthetic and functional satisfaction, as well as improved aesthetic evaluation by independent surgeons.</p></div><div><h3>Conclusions</h3><p>The use of local flaps permits a more pleasing reconstruction (functionally and aesthetically) of post-oncological tissue defects of the face.</p></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"42 ","pages":"Pages 97-112"},"PeriodicalIF":1.5,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S235258782400127X/pdfft?md5=d1f5e26aa959387751f1650fad5423bf&pid=1-s2.0-S235258782400127X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JPRAS OpenPub Date : 2024-08-23DOI: 10.1016/j.jpra.2024.08.007
Giuseppe Lanzano , Filomena Napoli , Teresa Zannella , Roberta Colucci , Ida Cantiello , Giuseppe Scalera
{"title":"Correlation between BMI, amount of aspirated fat and post-operative complications in VASER liposuction: A single centre experience","authors":"Giuseppe Lanzano , Filomena Napoli , Teresa Zannella , Roberta Colucci , Ida Cantiello , Giuseppe Scalera","doi":"10.1016/j.jpra.2024.08.007","DOIUrl":"10.1016/j.jpra.2024.08.007","url":null,"abstract":"<div><h3>Background</h3><p>Vibration amplification of sound energy at resonance (VASER) liposuction is an innovative technique that allows surgeons to selectively remove fat and shape desired areas of the body, resulting in more precise and controlled outcomes compared to traditional liposuction techniques. VASER liposuction offers several advantages, including targeted action that reduces trauma to the surrounding tissues, limiting pain, swelling and recovery time.</p></div><div><h3>Purpose</h3><p>This study compared the complication rates among patients who underwent VASER liposuction in relation to their body mass index (BMI) and the amount of fat aspirated.</p></div><div><h3>Methods</h3><p>The authors reviewed the medical records of all patients who underwent VASER liposuction at Scalera Clinic in Naples, dividing them into two groups: the first with BMI < 24.9 kg/m<sup>2</sup> and second with BMI >25.0 kg/m<sup>2</sup>.</p></div><div><h3>Results</h3><p>The authors examined 117 patients who were operated on within a year (2022/2023), with 48 of them having BMIs < 24.9 kg/m<sup>2</sup> and 69 showing BMIs >25.0 kg/m<sup>2</sup>. In patients with a BMI >25 kg/m<sup>2</sup>, the most common complications were contusion, hematomas and abnormal skin retraction, whereas no complications were observed in the patients with normal-weight.</p></div><div><h3>Conclusions</h3><p>To minimise post-operative complications and maximise results, it is advisable to select patients based on their BMI assessment, the anatomy of the treated body area and the volume of fat to be removed. This approach aims to ensure that the patients are suitable for the procedure and the achieved results align with their aesthetic expectations.</p></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"42 ","pages":"Pages 170-177"},"PeriodicalIF":1.5,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352587824001293/pdfft?md5=62b49017b7991dd4b4d96e566082ac6c&pid=1-s2.0-S2352587824001293-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142274804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Efficacy of superficial femoral artery as a recipient in free flap reconstruction around the knee: Four case reports and a literature review","authors":"Mitsutoshi Ota , Makoto Motomiya , Naoya Watanabe , Kazuya Kitaguchi , Norimasa Iwasaki","doi":"10.1016/j.jpra.2024.08.001","DOIUrl":"10.1016/j.jpra.2024.08.001","url":null,"abstract":"<div><h3>Purpose</h3><p>Reconstructing soft tissue defects around the knee with free flaps presents challenges in recipient vessel selection. Although the superficial femoral artery (SFA) offers exposure ease and anatomical stability, concerns arise regarding its distance from the defect site, difficulty in performing anastomosis and potential peripheral ischaemia. This study aimed to reassess the suitability of SFA as a recipient vessel for knee reconstructions by examining our cases and those from previous reports.</p></div><div><h3>Methods</h3><p>We reviewed four cases of knee soft tissue defects reconstructed with free flaps using the SFA, detailing surgical techniques and outcomes. Additionally, a comprehensive literature search was conducted for articles on using SFA as a recipient vessel for knee free flaps, using PubMed, Web of Science and EBSCOhost databases.</p></div><div><h3>Results</h3><p>In all four cases, latissimus dorsi (LD) flaps were used, with end-to-side anastomosis performed using a large slit-shaped arteriotomy. All flaps demonstrated successful survival without complications. Our analysis included 85 cases, comprising four of our cases and 81 cases from 16 articles. Sarcoma resection was the most common aetiology, followed by total knee prosthesis-related defects, trauma and osteomyelitis. Complete flap necrosis occurred in 5% of cases. The LD flap was the predominant choice, alongside other long-pedicle flaps. The SFA provided coverage for all knee areas except the distal lateral patellar region.</p></div><div><h3>Conclusion</h3><p>Despite the limited evidence, the SFA appears to be a reliable recipient vessel for knee soft tissue reconstruction. Comprehensive understanding of the characteristics of the SFA and flaps used enhances the safety and efficacy of soft tissue defect reconstruction around the knee.</p></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"42 ","pages":"Pages 81-96"},"PeriodicalIF":1.5,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352587824001232/pdfft?md5=84a0c459084f3b6a18eff074bda745ae&pid=1-s2.0-S2352587824001232-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JPRAS OpenPub Date : 2024-08-20DOI: 10.1016/j.jpra.2024.08.002
M.E.P. Rijkx , E. Bernardi , S.J. Schop , E.M. Heuts , M.B.I. Lobbes , J.E. Hommes , A. Piatkowski de Grzymala , T.J.A. van Nijnatten
{"title":"Radiologic findings in women after Autologous Fat Transfer (AFT) based breast reconstruction: A Systematic Review","authors":"M.E.P. Rijkx , E. Bernardi , S.J. Schop , E.M. Heuts , M.B.I. Lobbes , J.E. Hommes , A. Piatkowski de Grzymala , T.J.A. van Nijnatten","doi":"10.1016/j.jpra.2024.08.002","DOIUrl":"10.1016/j.jpra.2024.08.002","url":null,"abstract":"<div><h3>Purpose</h3><p>Autologous fat transfer (AFT) is increasingly used in breast reconstructive surgery. Due to post-surgical changes, in breast imaging after AFT, it can be challenging to differentiate between benign and suspicious findings. This systematic review aimed to present an overview of the literature on breast imaging after AFT-based breast reconstruction. The descriptive radiologic findings focus on different breast imaging modalities (i.e., mammography (MG), ultrasound (US), and breast magnetic resonance imaging (MRI)) to provide an overview of the most commonly reported benign and suspicious findings.</p></div><div><h3>Results</h3><p>The literature search yielded 20 studies from 2006-2022 that reported AFT-based breast reconstructions and included the radiologic evaluation of the included breast imaging modalities. Only six of the 20 included studies provided qualitative descriptions of radiologic findings. Fat necrosis was most frequently reported. On MG, fat necrosis was described in a variety of stages such as oil cyst or cytosteatonecrosis with or without calcifications. On US, it was described as a nonvascular hypo- or anechoic mass, and on breast MRI, it was most frequently reported as hypointense homogenous architectural distortion. Additional biopsies to differentiate between benign and malignant findings after AFT-based breast reconstruction were reported in 13 of the 20 studies. Among all included studies in the current review, a total of 34 of 137 biopsies were considered malignant (24.8%).</p></div><div><h3>Conclusion</h3><p>Qualitative descriptions of the reported radiologic findings after AFT for breast reconstruction were limited. Additional biopsies can be considered to differentiate between benign and suspicious findings. More experience and research are necessary to improve the interpretation of breast imaging after AFT-based breast reconstructions.</p></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"42 ","pages":"Pages 113-132"},"PeriodicalIF":1.5,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352587824001244/pdfft?md5=3542eec21e4e7ab6cf406074fb6de051&pid=1-s2.0-S2352587824001244-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142169523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JPRAS OpenPub Date : 2024-08-20DOI: 10.1016/j.jpra.2024.08.003
Hester Lacey, Kaneka Bernard, Labib Syed, Evie O'Rourke, Yasmin Calvert-Ford, Joanna Bovis, Enis Guryel, Ian King
{"title":"Orthoplastics Management of Open Lower Limb Fractures at a Major Trauma Centre: Audit of Adherence to BOAST4 Guidelines","authors":"Hester Lacey, Kaneka Bernard, Labib Syed, Evie O'Rourke, Yasmin Calvert-Ford, Joanna Bovis, Enis Guryel, Ian King","doi":"10.1016/j.jpra.2024.08.003","DOIUrl":"10.1016/j.jpra.2024.08.003","url":null,"abstract":"<div><h3>Introduction</h3><p>The British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) guide the optimal management of open lower limb fractures. Adherence of the newly established Orthoplastic service at the Major Trauma Centre covering the Southeast of England was audited in relation to these standards.</p></div><div><h3>Materials and methods</h3><p>Audit standards were produced. Data were collected using hospital records and the Trauma Audit and Research Network database. All open lower limb fractures managed between August 2020-August 2022 were included. Data collected included patient and injury demographics, and information related to initial and definitive management.</p></div><div><h3>Results</h3><p>Overall, 133 patients were identified, 70 men and 63 women, with an average age of 58 years. Women had a higher average age (69 years) and ASA grade (71% ASA 3 or higher). Low-energy injuries occurred in 69% of women compared to 78% of high-energy injuries in men (p<0.001). Among them, 108 (81%) were debrided within 24 h. The average time to first debridement was 18.78 h, and 95 (75%) were definitively closed within 72 h, 76 with primary closure, 7 with split-thickness skin graft, 7 with local flap and 36 with free flap. Overall, the post-operative infection rate was 13% with 94% of these fractures definitively closed within 72 h.</p></div><div><h3>Conclusion</h3><p>Most open lower limb fractures occurred in older women with higher ASA grade, from low-energy mechanisms. Most injuries were definitively managed as per the BOAST guidelines, but further efforts are required to improve the adherence to initial debridement targets, including training, appropriate resource allocation and implementation of procedures and proformas to guide injury management and improve documentation.</p></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"42 ","pages":"Pages 133-145"},"PeriodicalIF":1.5,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352587824001268/pdfft?md5=d9384fc7e4801f177f96a40efd9ed0bf&pid=1-s2.0-S2352587824001268-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}