Reconstruction of Gustilo IIIC Injuries of the Lower Extremity.

Abstract

BACKGROUND\nGustilo type IIIC open tibia fractures are characterized by an ischemic limb requiring immediate arterial repair. In this patient population, the decision between primary amputation and limb salvage can be challenging. This study aims to evaluate the reconstructive outcomes of patients with Gustilo IIIC injuries.\n\n\nMETHODS\nA single-center retrospective review of 806 lower extremity free flaps from 1976 - 2016 was performed. Flap loss and salvage rates for patients with Gustilo IIIC injuries were determined. To determine the utility of performing salvage in this group, outcomes of the IIIC reconstructions were compared to similar patients with Gustilo IIIB patients with only a single patent vessel.\n\n\nRESULTS\nA total of 32 patients with Gustilo IIIC injuries underwent reconstruction after traumatic injury. Ten patients (31.3%) experienced a perioperative complication, including: seven unplanned returns to the operating room (21.9%), three partial flap losses (9.4%), and five complete flap losses(15.6%). When IIIC injuries were compared with single vessel Gustilo IIIB injuries, no statistically significant differences were noted with respect to major perioperative complications (p= 0.527); unplanned return to the operating room (p= 0.06), partial flap loss (p= 0.209), complete flap loss (p= 0.596) or salvage rate (p= 0.368). Though not significant, Gustilo IIIC injuries trended toward lower takeback rates and higher salvage rates compared to single-vessel Gustilo IIIB injuries.\n\n\nCONCLUSIONS\nPatients with Gustilo type IIIC open tibia fractures should be considered candidates for limb salvage as flap loss and reconstruction of these injuries are comparable with the routinely reconstructed single-vessel runoff type IIIB injuries.