Role of Combined Ortho-Plastic Approaches in the Reconstruction of Gustilo–Anderson Grade III Upper Limb Injuries: A Systematic Review

TL;DR

This review shows that combining orthopedic and plastic surgery early improves outcomes for severe upper limb injuries.

Contribution

The study highlights the effectiveness of coordinated ortho-plastic approaches in managing Gustilo-Anderson Grade III upper limb injuries.

Findings

Early intervention within 72 hours achieved 100% limb salvage rates and reduced deep infections to 2.4%.

Vascularized flap coverage was critical for tissue viability and bone healing in complex trauma cases.

Both single-stage and staged procedures showed positive results in treating severe upper limb fractures.

Abstract

This systematic review investigates the role of combined ortho-plastic approaches in the reconstruction of Gustilo-Anderson Grade III upper limb fractures, which are characterized by severe soft tissue damage, contamination, and high rates of complications such as infection and nonunion. A total of five studies, encompassing 196 patients, were analyzed following a systematic search across PubMed, Embase, Scopus, and the Cochrane Library in accordance with PRISMA 2020 guidelines. The included studies evaluated early multidisciplinary interventions involving orthopedic fixation and plastic surgical soft tissue reconstruction. Early intervention, particularly within 72 hours was associated with improved outcomes, including limb salvage rates up to 100%, reduced deep infection rates as low as 2.4%, and union rates up to 84.3%. Both single-stage and staged procedures showed positive results, with vascularized flap coverage playing a crucial role in maintaining tissue viability and promoting bone healing. The findings strongly support the use of coordinated ortho-plastic strategies to manage complex upper limb trauma, although further prospective, high-quality trials are needed to standardize timing and techniques.

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