gms | German Medical Science

130. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

30.04. - 03.05.2013, München

Impact of Systemic Injury on Free Flap Outcomes in Trauma Patients

Meeting Abstract

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  • Jurij Kiefer - BG Unfallklinik Ludwigshafen, Plastische Chirurgie, Ludwigshafen
  • Scott T. Hollenbeck - Duke University Hospital, Department of Plastic Surgery, Durham
  • L. Scott Levin - University of Pennsylvania, Philadelphia
  • Christian Andreas Radu - BG Unfallklinik Ludwigshafen, Plastische Chirurgie, Ludwigshafen

Deutsche Gesellschaft für Chirurgie. 130. Kongress der Deutschen Gesellschaft für Chirurgie. München, 30.04.-03.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. Doc13dgch605

doi: 10.3205/13dgch605, urn:nbn:de:0183-13dgch6053

Veröffentlicht: 26. April 2013

© 2013 Kiefer et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Einleitung: With improvements in trauma care, outcomes of patients with critical injuries have improved. Severely injured patients are more likely to survive and present with devastating wounds requiring reconstructive procedures. Free tissue transfer is a proven method for treating traumatic injuries; however the role and safety of this technique in patients with concomitant systemic injuries remains unclear.

Material und Methoden: A retrospective review of all free flaps performed for traumatic injuries between January 1997 and December 2006 by a single surgeon (LSL) was performed. Patient demographics, comorbidities, treatment and outcomes were evaluated. Injury severity scores (ISS) were determined for all patients.

Ergebnisse: A total of 170 free flaps were performed on 160 patients during this time period. 79 patients had injury wounds in the absence of distinct systemic injuries (Group 1). 81 patients had injury wounds in the presence of distinct systemic injuries (Group 2). The mean age and comorbidities were similar in both groups. The ISS was significantly higher in Group 2 (21.5 versus 9.4; p<0.05). A significantly greater proportion of patients in Group 2 sustained injuries secondary to motor vehicle collisions (95.1% versus 20.3%; p<0.05). Overall flap survival was 92% and total surgical complication rate was 30%, neither of which significantly differed between groups. Length of stay was significantly greater in Group 2 (19.9 days versus 14.1 days; p<0.05). Subgroup analysis of systemically injured patients demonstrated that ISS was not predictive of flap loss or complications. Furthermore, patients with pulmonary contusion and / or intracranial injury did not portend a worse perioperative outcome.

Schlussfolgerung: In this selected group of patients we did not find a significant difference in free flap survival or overall early outcome relative to the presence or absence of systemic injury. This highlights the importance of clinical judgment in determining which patients may be suitable for free tissue transfer. As acute care continues to improve, the complexity and severity of injured patients potentially managed with free tissue transfer will further evolve.