Rafael Felix P Tiongco, Siam K Rezwan, Sami Alahmadi, Matthew J Heron, Scott A Sylvester, Stella M Seal, Tim de Jong, Ala Elhelali, Lily R Mundy
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We included studies of 10 or more patients undergoing flap reconstruction for open lower extremity fractures. We extracted data on patient demographics, operative details, and postoperative complications and grouped individual data by time-to-flap: 72 hours or less versus more than 72 hours and 7 days or less versus more than 7 days. We performed meta-analyses at a significance level of α equal to 0.05.</p><p><strong>Results: </strong>Sixteen studies of 973 patients (986 extremities) were included. Reconstruction within 72 hours of injury was associated with a 52% reduction in infection (risk ratio [RR] 0.48 [95% confidence interval (CI) 0.25-0.89]) and a 41% reduction in all complications (RR 0.59 [95% CI 0.36-0.99]). Reconstruction within 7 days of injury was associated with a 50% reduction in infection (RR 0.50 [95% CI 0.31-0.82]) but no significant reduction in total complications (RR 0.57 [95% CI 0.28-1.15]).</p><p><strong>Conclusions: </strong>Flap coverage within 72 hours of injury reduces infection risk in patients undergoing lower extremity reconstruction for open fractures.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 6","pages":"e6829"},"PeriodicalIF":1.5000,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12144651/pdf/","citationCount":"0","resultStr":"{\"title\":\"Early Flap Reconstruction and Infection Rates in Open Lower Extremity Fractures: A Systematic Review and Meta-analysis.\",\"authors\":\"Rafael Felix P Tiongco, Siam K Rezwan, Sami Alahmadi, Matthew J Heron, Scott A Sylvester, Stella M Seal, Tim de Jong, Ala Elhelali, Lily R Mundy\",\"doi\":\"10.1097/GOX.0000000000006829\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Severe open lower extremity fractures often require soft tissue reconstruction with a flap. 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引用次数: 0
摘要
背景:严重的下肢开放性骨折通常需要用皮瓣重建软组织。感染是下肢皮瓣覆盖的常见并发症,与住院时间长、费用高和患者报告的预后差有关。从损伤到皮瓣覆盖的时间会增加感染风险,但最佳时间阈值仍有争议。我们的目的是综合文献,并确定皮瓣的时间是否与创伤性下肢损伤后感染率的降低有关。方法:检索5个数据库中2023年3月前发表的文章。我们纳入了10例或更多接受皮瓣重建治疗开放性下肢骨折的患者的研究。我们提取了患者人口统计学、手术细节和术后并发症的数据,并按皮瓣时间对个体数据进行了分组:72小时或更短vs大于72小时,7天或更短vs大于7天。我们进行meta分析,显著性水平为α = 0.05。结果:纳入16项研究,973例患者(986条肢体)。损伤72小时内重建与感染减少52%(风险比[RR] 0.48[95%可信区间(CI) 0.25-0.89])和所有并发症减少41% (RR 0.59[95%可信区间(CI) 0.36-0.99])相关。损伤后7天内重建与感染减少50%相关(RR 0.50 [95% CI 0.31-0.82]),但总并发症没有显著减少(RR 0.57 [95% CI 0.28-1.15])。结论:损伤72小时内皮瓣覆盖可降低开放性骨折下肢重建术患者的感染风险。
Early Flap Reconstruction and Infection Rates in Open Lower Extremity Fractures: A Systematic Review and Meta-analysis.
Background: Severe open lower extremity fractures often require soft tissue reconstruction with a flap. Infection is a common complication of lower extremity flap coverage and is associated with prolonged hospitalization, high costs, and poor patient-reported outcomes. Elapsed time from injury to flap coverage can increase infection risk, but the optimal timing threshold remains debatable. We aimed to synthesize the literature and determine if time to flap is associated with reduced infection rates following traumatic lower extremity injuries.
Methods: We searched 5 databases for articles published before March 2023. We included studies of 10 or more patients undergoing flap reconstruction for open lower extremity fractures. We extracted data on patient demographics, operative details, and postoperative complications and grouped individual data by time-to-flap: 72 hours or less versus more than 72 hours and 7 days or less versus more than 7 days. We performed meta-analyses at a significance level of α equal to 0.05.
Results: Sixteen studies of 973 patients (986 extremities) were included. Reconstruction within 72 hours of injury was associated with a 52% reduction in infection (risk ratio [RR] 0.48 [95% confidence interval (CI) 0.25-0.89]) and a 41% reduction in all complications (RR 0.59 [95% CI 0.36-0.99]). Reconstruction within 7 days of injury was associated with a 50% reduction in infection (RR 0.50 [95% CI 0.31-0.82]) but no significant reduction in total complications (RR 0.57 [95% CI 0.28-1.15]).
Conclusions: Flap coverage within 72 hours of injury reduces infection risk in patients undergoing lower extremity reconstruction for open fractures.
期刊介绍:
Plastic and Reconstructive Surgery—Global Open is an open access, peer reviewed, international journal focusing on global plastic and reconstructive surgery.Plastic and Reconstructive Surgery—Global Open publishes on all areas of plastic and reconstructive surgery, including basic science/experimental studies pertinent to the field and also clinical articles on such topics as: breast reconstruction, head and neck surgery, pediatric and craniofacial surgery, hand and microsurgery, wound healing, and cosmetic and aesthetic surgery. Clinical studies, experimental articles, ideas and innovations, and techniques and case reports are all welcome article types. Manuscript submission is open to all surgeons, researchers, and other health care providers world-wide who wish to communicate their research results on topics related to plastic and reconstructive surgery. Furthermore, Plastic and Reconstructive Surgery—Global Open, a complimentary journal to Plastic and Reconstructive Surgery, provides an open access venue for the publication of those research studies sponsored by private and public funding agencies that require open access publication of study results. Its mission is to disseminate high quality, peer reviewed research in plastic and reconstructive surgery to the widest possible global audience, through an open access platform. As an open access journal, Plastic and Reconstructive Surgery—Global Open offers its content for free to any viewer. Authors of articles retain their copyright to the materials published. Additionally, Plastic and Reconstructive Surgery—Global Open provides rapid review and publication of accepted papers.