Soft-tissue reconstruction for exposed orthopedic implants in injured extremities

Abstract

Background: Exposure of orthopedic implants before fracture union is quite frequent in clinical practice. There is no definite rule as of now whether to retain or replace the exposed implant with an external fixator. Objectives: The aim of the study was to find the ultimate outcome after retaining the exposed implant and providing a skin and soft-tissue cover. Materials and Methods: Thirty-two patients with exposed orthopedic implants reported to us with an average of 6 weeks after the original orthopedic procedure. The local soft-tissue infection was treated with a targeted antibiotic therapy. There was delay in the soft-tissue reconstruction for an average of 24 days. Six patients also received “negative pressure wound therapy.” The soft-tissue defects (ranging from 4 cm × 3 cm to 25 cm × 10 cm) were compounded with exposure of olecranon plate in four and intramedullary tibia nails in five, and 23 exposed plates and screws. The various muscle and fasciocutaneous flaps were used according to the region of the defect. Results and Conclusions: All the flaps behaved well except one. One of the patients suffered from wound discharge and chronic sinus, but none suffered from pain or fracture nonunion up to 9 months follow-up. Removal of the implant was required in only one patient because of sharp edge. Thus, coverage of exposed implants should always be considered as the first option before replacing it with external fixator.