Abstract
Background and objectives: Complex limb wounds with multiple tissue involvement are commonly due to high energy trauma. Tissue damage is a dynamic entity and the exact extent of the injury is rarely instantly perceptible. Hence, reconstruction frequently involves a multi-stage procedure concluding with tissue replacement. Materials and Methods: A retrospective study was conducted between 2006 and 2018 and included 179 patients with contaminated multi-tissue injuries treated with hyperbaric oxygen therapy, negative pressure therapy, physiotherapy and drug treatment associated with multiple surgical time in a multistep approach, focusing on pain levels and wound closure rates. Results: Despite the long-term response to traumatic events, a combined approach of delayed surgical reconstructive time in mangled upper limb yielded satisfactory functional outcomes. Conclusions: The complex upper limb wound with deep tissue exposure may be treated with a multi-stage procedure alternatively to immediate reconstruction. The integrated technique enables the preservation of existing healthy tissue and concurrent radical debridement, reducing the risk of infection, as well as avoiding the loss of free flaps and dehiscence due to incorrect wound estimation.
Highlights
The incidence of complex trauma has decreased considerably over the years due to increasingly effective protection systems, public awareness campaigns and precise legislation regarding accident prevention on the workplace and elsewhere
179 (20%) patients were diagnosed with a complex trauma of the upper limb, with complicated infection, subject to therapy and are reported —129 (72%) males and 50 (28%)
No significant differences in age, smoking status, diabetes, hypertension, immune status or mechanism of injury were observed between patients who were subjected to negative pressure therapy (NPT) or Hyperbaric oxygen therapy (HBOT) and those not subjected to the respective management
Summary
The incidence of complex trauma has decreased considerably over the years due to increasingly effective protection systems, public awareness campaigns and precise legislation regarding accident prevention on the workplace and elsewhere. A mangled injury is the result of multiple tissue damage which may involve the bone, skin, vasculature and the nervous system, provoking significant bone and soft-tissue loss and a high potential for contamination. Complex limb wounds with multiple tissue involvement are commonly due to high energy trauma. Materials and Methods: A retrospective study was conducted between 2006 and 2018 and included 179 patients with contaminated multi-tissue injuries treated with hyperbaric oxygen therapy, negative pressure therapy, physiotherapy and drug treatment associated with multiple surgical time in a multistep approach, focusing on pain levels and wound closure rates. Results: Despite the long-term response to traumatic events, a combined approach of delayed surgical reconstructive time in mangled upper limb yielded satisfactory functional outcomes
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