Wound surface area as a risk factor for flap complications among patients with open fractures

Phelan Shea, Nathan N. O'Hara, Sheila A. Sprague, Mohit Bhandari, Brad A. Petrisor, Kyle J. Jeray, Min Zhan, Gerard P. Slobogean, Raymond A. Pensy, Gordon H. Guyatt, Stephen D. Walter, Emil H. Schemitsch, Paul Tornetta, Jeff Anglen, Michael Bosse, Susan Liew, Parag Sancheti, Paula McKay, Kim Madden, Kerry TaiDiane Heels-Ansdell, Lisa Buckingham, Aravin Duraikannan, Stephanie L. Tanner, Rebecca G. Snider, Douglas Altman, Rajiv Gandhi, Markus Bischoff, Gregory J.Della Rocca, Bill Ristevski, Krishan Rajaratnam, Dale Williams, Matthew Denkers, Drew Bednar, John Sadler, Desmond Kwok, Brian Drew, Ivan Wong, Jeremy A. Hall, Michael D. McKee, Henry Ahn, Daniel Whelan, James Waddell, Timothy Daniels, Earl Bogoch, Aaron Nauth, Milena R. Vicente, Jennifer T. Hidy, David Sanders, Abdel Rahman Lawendy, Kevin Gurr, Timothy Carey, Chris Bailey, Mark Macleod, Debra Bartley, Christina Tieszer, Chad Coles, Ross Leighton, C. Glen Richardson, Michael Biddulph, Michael Gross, Michael Dunbar, J. David Amirault, David Alexander, Catherine Coady, Mark Glazebrook, David Johnston, William Oxner, J. Andrew Trenholm, Gerald Reardon, Kelly Trask, Shelley MacDonald, Steven Papp, Wade Gofton, Stephen Kingwell, Joseph O'Neill, Garth Johnson, Eugene Wai, Julia Foxall, Henry M. Broekhuyse, Peter J. O'Brien, Piotr A. Blachut, Kelly A. Lefaivre, Raman Johal, Stéphane Leduc, G. Yves Laflamme, Pierre Beaumont, Michel Malo, Benoit Benoit, Dominique Rouleau, Pierre Ranger, Julie Fournier, Karine Tardif, Rudy Reindl, Greg Berry, Edward Harvey, William Fisher, Mark Burman, Paul Martineau, Eric Lenczner, Robert Marien, Robert Turcotte, Michael Tanzer, Max Talbot, Peter Jarzem, Mike Weber, Fiona Houghton, Robert McCormack, Kelly Apostle, Dory Boyer, Farhad Moola, Bertrand Perey, Trevor Stone, Darius Viskontas, H. Michael Lemke, Mauri Zomar, Karyn Moon, Raely Moon, Hans Kreder, Richard Jenkinson, David Stephen, Markku Nousiainen, Terry Axelrod, Veronica Wadey, Michael Ford, Joel Finkelstein, Richard Holtby, Robin Richards, Sebastian Rodriguez-Elizalde, Diane Nam, Albert Yee, Patrick Henry, John Murnaghan, Harsha Malempati, Julian Sernik, Tim Dwyer, Katrine Milner, Monica Kunz, Melanie MacNevin, Wesley Ghent, Fathima Adamsahib, Ria De Gorter, Michelle Arakgi, Ted V. Tufescu, Brad Pilkey, Chris Graham, Laurie Barron, Allan Hammond, Nigar Sultana, Ryan T. Bicknell, David Pichora, Aaron Campbell, Fiona Howells, Annie Deshaies, Frédéric Balg, François Cabana, Rejean Dumais, Jean François Joncas, Marc André Magalhaes-Grave, Nicolas Patenaude, Bernard LaRue, Stéphane Ricard, Chantal Théorêt, François Vézina, Amy Svotelis, Jennifer Downey, Stéphane Pelet, Jean Lamontagne, Luc Bédard, Alexandre Denault, Pierre Lavallée, Luc Petitclerc, Bernard Laliberté, Martin Bédard, Marie Eve Roger, Luc Lemire, Hélène Côté, Linda Lépine, Pascale Lévesque-Bernier, J. Scott Broderick, David R. Goetz, Thomas M. Schaller, Scott E. Porter, Michael L. Beckish, John D. Adams, Benjamin B. Barden, Grant W. Bennett, David M. Conner, Aaron T. Creek, Melissa M. Earles, Stephen H. Finley, Jonathan L. Foret, Garland K. Gudger, Richard W. Gurich, Austin D. Hill, S. Matthew Hollenbeck, Lyle T. Jackson, Benjamin S. Koch, Kevin K. Kruse, Wesley G. Lackey, Justin W. Langan, Julia Lee, Lauren C. Leffler, Michael J. Maughon, S. Brennan McClure, Timothy J. Miller, R. Lee Murphy, Lawrence K. O'Malley, Dustin M. Price, Lorra M. Sharp, J. Adam Smitherman, John A. Tanksley, Erick G. Torres, Dylan J. Watson, Scott T. Watson, Shea A. Bielby, Lauren A. Nastoff, Robert J. Teasdall, Joseph Hsu, Katherine M. Bedigrew, Tod Gerlinger, Dave Brown, Joseph Alderete, Kevin Kirk, Mickey Cho, Anthony Johnson, Raymond Topp, Damian Rispoli, James Ficke, Eric Ritchie, Anthony Beardmore, Siraj Sayeed, Michael Charlton, Kristen Walick, Dmitry Tuder, Greg Maytok, Travis Burns, Donald Gajewski, Warren Kactmas, Ramnov Andreson, Patrick Osborn, Michael Connally, Donna Lopez, Mary Fan, Dennis Mann, Andrea Garza, Rina L. Harman, Steven Olson, Robert Zura, Rachel Reilly, Prerana Patel, Claude T. Moorman, Fraser Leversedge, Chard Harbour, Brian Brigman, David Ruch, Nikoletta Leontaritis, Michael Bolognesi, Shalini Ramasunder, Alison Toth, Allen Diane, Grant Garrigues, Dean Taylor, Richard C. Mather, Kristoff Reid, Robert Lark, Samuel Adams, Maria Manson, Utku Kandemir, Saam Morshed, Murat Pekmezci, Richard Coughlin, Trigg McClellan, Meir Marmor, Eric Meinberg, Tigist Belaye, Jonathan Kwong, Clifford B. Jones, James R. Ringler, Terrence J. Endres, David J. Bielema, Michael R. Jabara, Samuel G. Agnew, Debra L. Sietsema, Jane E. Walker, Gregory J. Della Rocca, Brett D. Crist, Yvonne M. Murtha, David A. Volgas, James P. Stannard, Linda K. Anderson, Kelly M. Sullivan, Lori Kramer Clark, Kathleen Markley, Stacee Clawson, Andrew Schmidt, Patrick Yoon, Thomas Varecka, Matthew Karam, Jerald R. Westberg, Lisa K. Cannada, Jason Stoneback, Kevin Kuhn, Erik Nott, Leslie Dillender, Karl Shively, Brian Mullis, Janos Ertl, Ripley Worman, Jeffrey Anglen, Valda Frizzell, Molly Moore, Michael J. Prayson, David Nelles, Jason Vourazeris, Matthew Ross, Richard T. Laughlin, Joseph Cox, Roman Trimba, Joy M. Bradford-Johnson, Andrew J. Marcantonio, Michael Kain, Richard Wilk, Mark Lemos, Joshua Baumfeld, John Tilzey, Brian Jolley, John Garfi, Ivan Tarkin, Andrew Evans, Peter Siska, Lisa Blackrick, Dana J. Farrell, Emily Keener, Jason Lowe, William Min, Jeffrey Leary, Rena Stewart, Leslie Barnes, Nurit Shadmi, Matthew Robinson, Taylor Vlack, Kathryn Hornbuckle, Melanese Leonard, Nikia Hawkins Malone, Tanya Nix, Jessica Goldstein, David Zamorano, Martin Tynan, Samuel Bederman, Nitin Bhatia, Arthur Kreitenberg, Bang Hoang, Deeba Pourmand, Deanna Lawson, Anthony Rhorer, Brian Miller, Gilbert Ortega, Lori Wood, Veronica Place, Harvinder Bedi, Ashley Carr, Andrew Chia, Hamish Curry, Steve Csongvay, Craig Donohue, Stephen Doig, Elton Edwards, Eugene Ek, Max Esser, Greg Etherington, Richard Freeman, Andrew Gong, Doug Li, Matthan Mammen, Russell Miller, Ash Moaveni, Mathias Russ, Lu Ton, Tom Treseder, Otis Wang, Zoe Murdoch, Claire Sage, Adam Dowrick, John Clarke-Jenssen, Frede Frihagen, Lars Nordsletten, Tor Nicolaysen, Hilde Apold, Petter Iversen, Are Stodle, Mette Andersen, Vera Halvorsen, Geir Hjorthaug, Anders Lippert, Ida Sletten, Ellen Langslet, Marius Molund, Asgeir Amundsen, Oliver Muller, Cathrine Aga, Torben Ianssen, Gunnar Flugsrud, Jonas Rydinge, Kim Hemlock, Jan Egil Brattgjerd, John Magne Hoseth, Bernhard Flatoy, Havard Furunes, Peder Bogsti, Guri Ekås, Gilbert Moatshe, Ali Al-Ashtari, Tore Fjalestad, Fredrik Nilsen, Morten Smedsrud, Anne Christine Brekke, Elise Berg Vesterhus, Sissel Knuts, Steve Rocha, Chetan Puram, Atul Patil, Neelam Jhangiani, Anil K. Rai, Kamal Narayan Rai, Vivek V. Jabade, Deepali Nassikars, Narayan J. Karne, Chetan Metha, A. Navaladi Shankar, A. Navaladi Shankar, R. Saravana, Ajay Gupta, Neeraj Jain, Mahesh Bhatia, Vinod Arora, Vivek Tyagi, Anoop Dubey, Vinit Yadav, Rani Rai, Kiran M. Doshi, Arjun Patil

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Background: Soft-tissue complications often dictate the success of limb salvage and the overall outcome of open fractures. Based on prior work at the R Adams Cowley Shock Trauma Center, the authors hypothesize that wounds larger than 200 cm2 are associated with a greater likelihood of both flap-related reoperation and wound complications among patients requiring soft-tissue reconstruction with a rotational flap or free tissue transfer. Methods: This study was a secondary analysis of Fluid Lavage in Open Wounds trial data that included all patients who received a rotational or free tissue flap transfer for an open fracture. The primary outcome was flap-related reoperation within 12 months of injury. The secondary outcome was wound complication, which included events treated operatively or nonoperatively. Multivariable logistic regression was used to assess the association between wound size and outcomes, adjusting for confounders. Results: Seventeen percent of the 112 patients required a flap-related reoperation. A wound size greater than 200 cm2 was not associated with reoperation in an unadjusted model (p = 0.64) or adjusting for Gustilo type (p = 0.70). The sample had an overall wound complication rate of 47.3 percent. Patients with a wound size of greater than 200 cm2 were three times more likely to experience wound complications (OR, 3.05; 95 percent CI, 1.08 to 8.62; p = 0.04) when adjusting for moderate to severe wound contamination and wound closure in the operating room. Conclusion: The findings of this study demonstrate that wound surface area is an integral determinant for wound complication following soft-tissue flap treatment, but found no association between wound surface area and flap-related reoperation rates.

Original languageEnglish (US)
Pages (from-to)228-236
Number of pages9
JournalPlastic and reconstructive surgery
Volume142
Issue number1
DOIs
StatePublished - 2018

ASJC Scopus subject areas

  • Surgery

Fingerprint Dive into the research topics of 'Wound surface area as a risk factor for flap complications among patients with open fractures'. Together they form a unique fingerprint.

  • Cite this

    Shea, P., O'Hara, N. N., Sprague, S. A., Bhandari, M., Petrisor, B. A., Jeray, K. J., Zhan, M., Slobogean, G. P., Pensy, R. A., Guyatt, G. H., Walter, S. D., Schemitsch, E. H., Tornetta, P., Anglen, J., Bosse, M., Liew, S., Sancheti, P., McKay, P., Madden, K., ... Patil, A. (2018). Wound surface area as a risk factor for flap complications among patients with open fractures. Plastic and reconstructive surgery, 142(1), 228-236. https://doi.org/10.1097/PRS.0000000000004418