Abstract: Soft Tissue Reconstruction and Salvage of Infected Fixation Hardware in Lower Extremity Trauma

Abstract

INTRODUCTION: Management of tibial fractures can be complicated by infection of internal fixation hardware, resulting in increased morbidity and amputation rate. When removal of infected internal hardware with external fixation is not possible, salvage of the lower extremity is attempted through debridement, antibiotics, and soft tissue coverage. The purpose of this study is to investigate salvage of lower extremities with retention of infected fixation hardware. METHODS: Tibial fractures requiring soft tissue reconstruction at a level I trauma center were reviewed from 2007–2015. Demographics, outcomes, and bacterial speciation were analyzed. The primary outcome was clinical suppression of infection, while secondary outcomes included limb salvage, hardware removal, amputation, and osseous union. RESULTS: Twenty-five patients underwent soft tissue reconstruction for salvage of infected internal fixation hardware. Average age was 41, 76% male, BMI 30.1 kg/m2, 40% of patients smoked, 96% of injuries were blunt. Tibial fractures were closed in 32%, Gustilo-Anderson grade I in 4%, II in 32%, IIIb in 20%, and IIIc in 4%. Staphylococcus was most commonly cultured with 44% methicillin-resistance. Soft tissue reconstruction was performed by local flap in 60% (73% gastrocnemius, 27% soleus), free flap in 40% (30% latissimus, 40% gracilis, 30% ALT). At 16.1 months, 76% of hardware salvage patients demonstrated clinical suppression of the infection, 57.9% rate of bony union, and 96% rate of limb salvage. One patient was amputated for recurrent infection. CONCLUSION: Following complex, infected tibial fractures, we demonstrate a 76% clinical rate of suppression of infected hardware, and 96% success in limb salvage.