Introduction: Severe open lower leg injuries can present a considerable challenge to management and are often performed through a two-stage orthoplastic approach. Delays in flap coverage have been associated with increased rates of infection ranging from 2-16% (1). Well recognized standards of care suggest optimization of time to free flap coverage and joint consultant planning and decision making (2). This audit of local procedures against standards of care in Canterbury poses a platform to which a local orthoplastic team can be enhanced for managing these injuries effectively.
Methodology: A retrospective audit was performed including open lower leg injuries that underwent definitive fixation and free flap coverage at Christchurch Hospital from January 2020 to December 2023. Our primary outcomes were time to soft tissue coverage, time between fixation and flap coverage and joint consultant decision making. Secondary outcomes included infection, flap failure, and non-union.
Results:There were eleven cases identified in the four-year period. The initial surgery involved a consultant orthopedic surgeon in nine cases and a consultant plastic surgeon in three cases. Definitive soft tissue coverage occurred on average 7.6 days after presentation (range 3-23 days). There was an average of 1.3 days between orthopedic fixation and free flap reconstruction (range 0-4 days). Deep infection occurred in 4/11 cases. Free flap failure occurred in 2/11 cases.
Conclusion:Audit of local management of open lower leg injuries requiring free-flap reconstruction against international guidelines enables opportunity to develop a gold standard orthoplastic service in Christchurch. Such approach will result in improved outcomes for these patients.