Wound Surface Area as a Risk Factor for Flap Complications among Patients with Open Fractures

BACKGROUND:Soft tissue complications often dictate the success of limb salvage and the overall outcome of open fractures. Based on prior work at our institution, we hypothesize that wounds greater than 200cm are associated with a greater likelihood of both flap-related reoperation and wound complications among patients requiring soft tissue reconstruction with a rotational flap or free tissue transfer. METHODS:We performed a secondary analysis of FLOW trial data that included all patients who received a rotational or free tissue flap transfer for an open fracture. Our primary outcome was flap-related reoperation within 12 months of injury. Our secondary outcome was wound complication, which included events treated operatively or non-operatively. Multivariable logistic regression was used to assess the association between wound size and the outcomes, adjusting for confounders. RESULTS:17.0% of the 112 patients required a flap-related reoperation. A wound size of greater than 200cm was not associated with reoperation in an unadjusted model (p=0.64) or adjusting for Gustilo type (p=0.70). The sample had an overall wound complication rate of 47.3%. Patients with a wound size of greater than 200 cm were three times more likely to experience wound complications (Odds Ratio3.05, 95% CI 1.08- 8.62, p=0.04) when adjusting for moderate-severe wound contamination and wound closure in the operating room. CONCLUSION:The findings of this study demonstrate that wound surface area is an integral determinant for wound complication following soft tissue flap treatment, but found no association between wound surface area and flap-related reoperation rates.