Abstract text (incl. references and figure legends)
Introduction
Deciding the time and method of wound closure in open tibial fractures is difficult, especially in the boundary case of Gustilo-Anderson type ⅢA or ⅢB. This retrospective cohort study aims to clarify the effect of delayed wound closure (DWC) in the "gray zone" cases compared to primary wound closure (PWC).
Material and methods
We retrospectively reviewed open tibial shaft fractures treated in one regional Japanese trauma center from 2013 to 2017. Among 47 type Ⅲ fractures, 22 fractures were either type ⅢC or ⅢB with extensive soft tissue loss and excluded from the cohort. Among the other 25 fractures, we included 14 fractures with exposure of fracture as boundary case of type ⅢA or ⅢB. At the initial treatment, we conducted debridement with fracture stabilization by an external fixator. PWC or Negative wound pressure therapy (NPWT) was applied to the open wound. Within a few days following the initial treatment, we conducted internal fixation. In DWC, the wound was closed a few days after the internal fixation. The primary outcome is the need for soft tissue reconstruction. The secondary outcome is the days before the final closure of the wound and complications related to the fracture. The result was compared between DWC and PWC.
Results
Ten patients (mean age 52.8) underwent DWC, and four patients (mean age 46) underwent PWC. Four patients (40%) in the DWC group and four (100%) in the PWC group required soft tissue reconstruction due to skin necrosis. For the final closure of the wound, 14.2±12.0 days were required in DWC group and 15.8±16.4 days were required in PWC group (p = 0.84). As a complication, one patient in DWC group and one patient in PWC group developed deep tissue infection.
Conclusions
DWC seems to be a safe option as a method of wound closure in open tibial fractures with the exposure of fracture. There is a need for further study to elucidate the effectiveness of DWC in reducing the need of soft tissue reconstruction.
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