Is this a “lucky LEG”? A retrospective analysis of the management of Lower-Entity Gustilo open fractures requiring flap coverage in the lower extremity

TL;DR

This study compares outcomes of lower-extremity open fractures requiring flap coverage, finding better results in cases with delayed soft-tissue damage.

Contribution

The study provides new insights into the management and outcomes of Gustilo-Anderson I to IIIA fractures requiring flap coverage.

Findings

The LEG group had longer delays before coverage and fixation compared to the HEG group.

The HEG group had higher deep infection rates and lower bone union rates despite shorter delays.

LEG fractures showed better outcomes despite longer treatment delays.

Abstract

Most of the literature about soft-tissue coverage of open fractures is focused on Gustilo-Anderson IIIB/IIIC. A significant proportion of the flaps performed for coverage after open fractures is however performed for Gustilo-Anderson types I to IIIA which develop soft-tissue damage over days after injury. This study aims at analyzing this specific subset of open fractures regarding characteristics, management and outcomes.

A retrospective study was conducted on patients who benefited from a pedicled or free flap coverage for open fractures of the lower extremity. Bone union and rate of deep infection were compared between patients presenting open fractures type I to IIIA (Lower Entity Gustilo—LEG) with secondary soft-tissue damage and patients who presented open fractures type IIIB and IIIC (Higher Entity Gustilo) with immediate soft-tissue damage.

Eighteen patients were included, seven of which were in the first group (LEG) and 11 in the second group (HEG). Time from injury to coverage was significantly longer for the LEG group (23.6 Vs 9.5 days) and so was the delay between definitive fixation and coverage (6.6 Vs 0.0 days). Rate of bone union was lower and rate of deep infection was higher in the HEG group (64% Vs 0%, p = 0.019).

Open fractures of the lower extremities type Gustilo-Anderson I to IIIA (LEG) which develop soft-tissue damage after injury eventually requiring flap coverage seem to have a lower risk of deep infection and delayed union despite longer delay between trauma and coverage as well as between definitive fixation and coverage.

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