Patient and Surgical Factors Contributing to Perioperative Infection in Complex Lower Extremity Trauma

Abstract

Infections in the traumatized lower extremity are a significant source of morbidity and expense. Outcomes after vascularized soft tissue reconstruction were analyzed to determine impact on infection rates. A retrospective review of a prospectively maintained database was performed, including 114 trauma patients requiring soft tissue reconstruction of lower extremity injuries at an urban Level I tertiary referral center from 2008 to 2015. Patient characteristics and perioperative outcomes were analyzed. After trauma, 39 (34.2%) patients developed wound infections, of which 74.4 per cent of infections occurred before soft tissue coverage. Isolated lower extremity injury yielded a 4-fold increase in the incidence of infection. Infection rates doubled in patients who smoked, sustained a fall, had a proximal third of the lower leg wound, or underwent external fixation. Comorbid diabetes, underlying fracture, and wound size were not predictive of infection. Overall, there was a 97.4 per cent rate of limb salvage after soft tissue reconstruction. In patients with infection before soft tissue reconstruction, a salvage rate of 96.6 per cent was achieved. Soft tissue reconstruction in the traumatized and infected lower extremity resulted in high limb salvage success rates, demonstrating vascularized tissue transfer in lower extremity injuries is effective in treating lower extremity infection.