Abstract
The treatment of severely injured extremities still presents a very difficult task
for trauma orthopaedic surgeons. Despite improvements in technology and surgical/microsurgical
techniques, sometimes a limb must be amputated, otherwise severe and potentially fatal
complications may develop. There is a well-established belief that severe open fractures
should be left open. However, Godina proved wound coverage in the first 72 h (after
an injury) to be safe and to bring good final results. So early wound cover (no later
than one week after an injury) with well vascularized free flaps became the gold standard.
Yet for many patients (some of whom have serious health problems), operative treatment
needs to be postponed when they arrive to specialized microsurgical departments for
microsurgical reconstruction much later than one week after incurring an injury. As
the definite wound cover period from one week to 3 months seems to be hazardous, especially
due to the potential of infection, we developed a safe, original flap technique that
prevents infection and covers important structures such as exposed bones, tendons,
nerves and vessels. We named this technique the “close–open–close free flap technique”.
It enables difficult wound cover in any biological phase of the wound, by combining
complete flap cover first, with the removal of stitches from one side of the flap
after 6–12 h. This technique works very well for borderline cases as well; where even
after a complete debridement, dead tissue still remains in the wound - making wound
cover very dangerous. Closing completely severe open fractures with free (or pedicled)
flaps and removing the stitches on one side after 6–12 h, enables orthopaedic surgeons
to safely cover any kind of wound in any biological phase of the wound. Additional
debridements, lavages and reconstructions can easily be performed under the flap and
after the danger of a serious infection has disappeared, definitive wound closure
can be carried out.
Keywords
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Article info
Publication history
Published online: October 23, 2019
Footnotes
This paper is part of a Supplement supported by the European Federation of Societies of Microsurgery (EFSM) and the Serbian Society for Reconstructive Microsurgery (SSRM).
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
