PR25 SOFT TISSUE COVERAGE IN LOWER LIMB TRAUMA – ANNUAL AUDIT FROM A TERTIARY RECONSTRUCTIVE SURGERY UNIT IN INDIA

Abstract

Purpose To discuss the entire spectrum of injuries seen in lower limb trauma and choice of reconstructive options.Methodology Retrospective review of 72 consecutive cases in one year.Data collected from individual case records and the department photo data base. Injuries were classified and analyzed based on bone and soft tissue involvement, associated vascular injuries, mechanism of injury as in crush, degloving, and combined. Bony injuries were classified according to Gustilo’s classification. Treatment options and outcome for bone and soft tissue are discussed separately.Results Total of 72 cases. 95%of cases were two wheeler traffic accidents. Distribution of cases according to site involved: Leg‐39; Foot‐14; Leg and foot‐16; Thigh, leg, and foot‐3. 8 of them were of Gustilo’s IIIB and 7 of IIIC. 42 flaps done included Gastrocnemius‐4, Soleus‐7, reverse sural‐7, Cross leg‐2, Fasciocutaneous‐5 Perforator based local flaps‐3Latissimus dorsi‐7, Gracilis‐6 Lateral thigh‐1 Intervention: Immediate: 12%. Early (less than 1 week): 36, Delayed (>1 week): 52% Complications:Wound infection:Minor: 12; Major: 8 (3 Cases – Clostridia) Partial flap loss: 6; Loss of SSG over flap/donor site: 5; Acute renal failure: 1 Amputations: Above knee: 4; below knee: 2 Conclusions This series represents the spectrum of high velocity injuries in an overcrowded urban locality of developing country. Significant tissue loss is most often the rule. A judicious execution of reconstructive options can optimize results. Management protocols were adopted to avoid delayed referrals. This audit served as a benchmark to put together a dedicated trauma team in our hospital.