Wound Surface Area as a Risk Factor for Flap Complications among Patients with Open Fractures

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Plastic and Reconstructive Surgery

Background:

• Soft-tissue complications significantly impact limb salvage and outcomes in open fractures.
• Large wounds (>200 cm²) were hypothesized to increase flap reoperation and wound complications.

Purpose of the Study:

• To investigate the association between open fracture wound size and outcomes after soft-tissue reconstruction using flaps.
• To determine if wound surface area predicts flap-related reoperation or wound complications.

Main Methods:

• Secondary analysis of Fluid Lavage in Open Wounds trial data.
• Included patients undergoing rotational or free tissue flap transfer for open fractures.
• Multivariable logistic regression assessed wound size association with flap reoperation and wound complications.

Main Results:

• A wound size >200 cm² was not associated with flap-related reoperation (p=0.70).
• Patients with wounds >200 cm² were three times more likely to experience wound complications (OR, 3.05; p=0.04).
• Overall wound complication rate was 47.3%.

Conclusions:

• Wound surface area is a key factor for wound complications after soft-tissue flap procedures.
• No association was found between wound surface area and flap-related reoperation rates.