Limb Reconstruction outside the Box
Stoke Mandeville Plastics
Guest speaker: David Wallace, Consultant Plastic Reconstructive Surgeon, Coventry, UK
Hosts: James K-K Chan & Rebecca Shirley
Topics: 3:15 David’s journey to trauma reconstruction
10:34 Standards in the Management of Open Fractures
13:16 Timing of debridement
15:33 How Standards have impacted on outcomes over last 10 years
17:00 The role of major trauma centres, timing and staging of surgical procedures
26:54 The importance of the Orthoplastics team
28:26 What happens if there is a long delay after skeletal fixation before soft tissue recon?
32:16 Negative Pressure Wound Therapy
35:15 When not to adhere to guidelines
40:53 When to salvage v amputation
47:35: Leadership
54:39: Q&A
References: Hull et al 2014 Bone Joint J
Delayed debridement of severe open fractures is associated with a higher rate of deep infection
PMID: 24589795
NICE guidance NG 37
D’Alleyrand et al 2014 J Orthop Trauma
Is time to flap coverage of open tibial fractures an independent predictor of flap-related complications?
PMID: 24296593
Matthews et al 2015 Injury
Single-stage orthoplastic reconstruction of Gustilo-Anderson Grade III open tibial fractures greatly reduces infection rates
PMID: 26391592
Borani et al 2017 JPRAS
Orthoplastic surgical collaboration is required to optimise the treatment of severe limb injuries: A multi-centre, prospective cohort study
PMID: 28351609
Costa et al 2018 JAMA
Effect of Negative Pressure Wound Therapy vs Standard Wound Management on 12-Month Disability Among Adults With Severe Open Fracture of the Lower Limb: The WOLLF Randomized Clinical Trial
PMID: 29896626
Costa et al 2020 JAMA
Effect of Incisional Negative Pressure Wound Therapy vs Standard Wound Dressing on Deep Surgical Site Infection After Surgery for Lower Limb Fractures Associated With Major Trauma: The WHIST Randomized Clinical Trial
PMID: 32044942
Hyldig et al 2016 BJS
Meta-analysis of negative-pressure wound therapy for closed surgical incisions
PMID: 26994715