Analyse du programme reconstruction membres inférieurs Amman

ANALYSIS AND CONCLUSIONS ABOUT LOWER LIMBS RECONSTRUCTIONS IN AMMAN CENTER

Louise Boulart Philippe Pelissier Patrick Herard

Amman Since 2006, > 2000 patients 50 new patients/month (173000 human loss since 2003)

Red Crescent Hospital

- 1 plastic surgeon - 1 maxillofacial surgeon - 3 orthopedic surgeons

Equipe - 4 half days OPD - 5 half days OT - 1 half day meeting

LOXER LIMBS RECONSTRUCTION

LOWER LIMBS RECONSTRUCTION

Patients Nb patients

504

Age (average)

32,1

Age (range)

Mecanism Bomb Bullet Car accident Crushed injury Explosion Fall Medical Shrapnels

From injury to Amman

2,5 > 66

1 142 50 2 263 11 5 19 493 average = 1030

Injuries Gustillo 0 F II IIIb IIIc

27 8 20 413 36

Initial Treatment N Y

101 403

Infection N Y

188 316

Injuries

Localization 1 2 3 4 5 6 7 F T TT

8

19 44

17

52

8 19 44 52 69 32 36 3 224 17

69

224

32 3 36

size of skin defect <5cm2 5-10cm2 10-15cm2 15-20cm2 >20cm2

18 32 30 17 11

size of bone defect >6cm2 34 3-6cm2 82 <3cm2 110

Procedures Nb procedures (average) Nb procedures (range)

2,8 1 Ă 25

Ortho Bone Graft

69

Debridment

77

Osteotomy

73

Osteosynthesis

208

Tendon Repair

6

Plastic Cross Leg Free bone flap Free fasciocutaneous flap Free muscular flap Vascular repair Pedicular fasciocuaneous flap Pedicular muscle flap Skin graft

6 2 5 22 5 32 18 58

Outcomes Total of complications N Y

Type of omplications Desunion Exposure Flap loss Hematoma Infection Not healed Pseudarthrosis Skin graft loss Skin necrosis

393 111

2 1 6 10 37 2 43 4 6

Outcomes

Stay in Amman (Mean) Stay in Amman (range)

Bone consolidation N

46

NA

31

Y

427

136 8 Ă 520

Healing of soft tissue N

22

Y

308

Amputation

N

Walking

Primary

23

Secondary

15

N

29

466

Y

243

Analysis

Severity of the initial trauma Gustillo II IIIb IIIc

1 54 14

Gustillo None Close II IIIb IIIc

Infection No Yes 14 13 4 4 13 7 146 267 11 25

Severity of the initial trauma

Gustillo none close II IIIb IIIc

1 1

22 2

3 9 4 11 125 8

Stay (months) in Amman 6 9 12 5 3 1 2 2 139 68 7 6

12

17

3 33 6

6 3

Influence of infection

Infection No Yes

Infection No Yes

Complication No Yes 171 17 222 94

Bone consolidation No NA Yes 5 12 171 41 19 256

Infection No Yes

Severity of complication Major Minor 10 7 82 12

Infection No Yes

Healing of soft tissue No Yes 5 129 17 179

Influence of infection Infection No Yes

Infection No Yes

Amputation 1 2 N 14 174 9 15 292

1 14 11

Stay (months) in Amman 3 6 9 12 82 55 19 6 75 108 63 36

17 1 8

Complications Total complications N Y

393 111

Infection Total complications N Y

N

Infection

Y 171 17

222 94

Severity of complications Major Minor

Amputation Total complications N Y

1 21 2

2N 10 362 5 104

N

Y 10 7

82 12

Amputation Severity of complications Major Minor

1 2

2N 5

85 19

Complications

Stay in Amman (months) Severity of complications Major Minor

1 1

3 17 8

6 32 8

9 22 2

12 15 1

17 1

Conclusion • Missing data • Infections > consequences +++ • Skin defects leads to amputation

Solutions?

• VAC therapy - Byrd HS, Cierney G, Tebbetts J. The management of open tibial fractures with associated soft-tissue loss: External pin fixation with early flap coverage. Plast Reconstr Surg. 1981; 68:73–82.

- Karanas YL, Nigriny J, Chang J. The timing of microsurgical recon- struction in lower extremity trauma. Microsurgery 2008;28:632–634 - Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg 1986;78:285–292.

- Rinker B, Amspacher JC, Wilson PC, Vasconez HC. Subatmospheric pressure dressing as a bridge to free tissue transfer in the treatment of open tibia fractures. Plast Reconstr Surg 2008;121:1664–1673.

Conclusion

> Home-made VAC!