BACKGROUND: Open lower leg @entity174 with exposed bone or tendon continue to be challenging for plastic surgeons. Microvascular free-tissue transfer increases the ability to close wounds, transfer vascularized bone, and prevent amputation, yet remains a complex, invasive procedure with significant complication rates, donor-site morbidity, and failure rates. This review documents the changing treatment protocol in the authors' institution for these injuries. METHODS: Two hundred ninety consecutive @entity4422 over a 12-year period (1992 to 2003) were retrospectively reviewed and methods and outcomes were compared by grouping the @entity174 into 4-year intervals. RESULTS: The number of open lower extremity @entity174 increased, whereas the distribution of Gustilo grade I to III @entity174 remained unchanged. Overall, free-tissue transfer was performed less frequently and constituted 20 percent of reconstructions in period 1 (1992 to 1995), 11 percent in period 2 (1996 to 1999), and 5 percent in period 3 (2000 to 2003). For the most severe @entity174 , Gustilo grade III, free-flap reconstruction has decreased significantly, constituting 42 percent, 26 percent, and 11 percent of procedures in periods 1, 2, and 3, respectively. Local flaps for grade III @entity174 have remained relatively constant throughout the study. In contrast, local wound care for grade III @entity174 , including skin grafts, delayed primary closures, and secondary intention closures has significantly increased from 22 percent to 49 percent of reconstructions from periods 1 through 3. In 1997, the authors began to use the vacuum-assisted closure device and now use it in nearly half of all open @entity174 . Despite this trend, there has been no change in infection, amputation, or malunion/nonunion rates and a decrease in reoperation rate with at least 1-year follow-up. CONCLUSIONS: These results demonstrate a change in practice, with a trend down the reconstructive ladder, currently using fewer free flaps and more delayed closures and skin grafts with frequent use of the vacuum-assisted closure sponge. Possible reasons for this change are a better understanding of lower leg vascular anatomy and better use of improved wound care technology.

Lower extremity trauma: trends in the management of soft-tissue reconstruction of XXXX .

@entity174 :: ('MESH:D050723', 'Disease') :: ['fractures'] @entity4422 :: ('MESH:D005597', 'Disease') :: ['open tibia-fibula fractures']
@entity4422 :: (MESH:D005597,Disease) :: ['open tibia-fibula fractures']
