Subatmospheric pressure dressing as a bridge to free tissue transfer in the treatment of open tibia fractures

Background: Free flap reconstruction performed shortly after injury is associated with reduced complications but is not always feasible. Subatmospheric pressure dressings have several beneficial effects on wounds. This study reviewed a large series of open tibia fractures to determine whether subatmospheric pressure dressings affected complication rates. Methods: One hundred five patients underwent free muscle flap reconstruction for open tibia fractures between 1991 and 2005. Patients were divided into three groups: acute (flap performed 1 to 7 days after injury), subacute (8 to 42 days after injury), and chronic (>42 days after injury). Five outcome measures were used: infectious complications, flap-related complications, surgical procedures, hospital stay, and time to bony union. The subacute group was divided into patients who underwent subatmospheric pressure dressing therapy and those who did not. Results: The complication rate in the subacute group (n = 55) was 47 percent, compared with 39 percent in the chronic group (n = 18) and 31 percent in the acute group (n = 32). Time to union was significantly shorter in the acute group than in the other groups. Subacute patients who underwent subatmospheric dressing therapy had lower overall complication (35 percent), infectious complication (6 percent), and flap-related complication rates (12 percent) than those who did not (53, 18, and 21 percent, respectively). Time to union was significantly shorter with the dressings. Conclusion: Subatmospheric pressure dressing therapy as a "bridge" to free flap reconstruction in patients with open tibia fractures was associated with reduced complication rates in the subacute group, suggesting that the dressings may effectively extend the acute period when early free tissue transfer is not possible.