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Meirizal M, Magetsari R, Anwar SL, Chaidir MR, Muhammad H, Baskara AANN, Pradipta MFW, Huwaidi AF. Utilizing Low-cost Vacuum-assisted Closure as Adjuvant Therapy in Soft Tissue Reconstruction for a Mangled Upper Extremity. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5826. [PMID: 38798936 PMCID: PMC11124598 DOI: 10.1097/gox.0000000000005826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/25/2024] [Indexed: 05/29/2024]
Abstract
Soft tissue reconstruction using flaps in managing mangled injuries is occasionally insufficient due to large defects and low flap viability. Conversely, delaying the closure of the defect can elevate the risk of infection. Adjuvant therapy becomes essential in the management of mangled injuries. We aim to present the use of low-cost vacuum-assisted closure (VAC) as an adjuvant therapy for mangled injuries. We reported the case of a 20-year-old man who sustained a mangled injury to his left forearm in a traffic accident 4 hours before admission. The mangled extremity severity score was 9; however, the patient declined amputation. Although the initial reconstruction was done, the flap could only cover vital structures. VAC was utilized to address the uncovered portion of the defect, to promote optimal granulation and prevent infection. The reconstruction proceeded with a skin graft and wrist arthrodesis. At 1-year follow-up, viable tissue was obtained but contracture occurred at the metacarpophalangeal and proximal interphalangeal joints. We intend to perform functional reconstruction at a later stage. Although the benefits of VAC in wound management are well established, reports regarding its advantages in mangled injury management remain relatively scarce. The high cost of VAC is a limiting factor, particularly in developing countries. This prompts the need for an affordable VAC innovation with comparable efficiency to the commercial model. Reverse Aqua Pump VAC, our innovative low-cost VAC, shows satisfactory outcomes in managing patients with mangled injuries with mangled extremity severity score indicating amputation.
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Affiliation(s)
- Meirizal Meirizal
- From the Doctoral Program in Medicine and Health Science, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Orthopedics and Traumatology Department, RSUP Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Rahadyan Magetsari
- From the Doctoral Program in Medicine and Health Science, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Orthopedics and Traumatology Department, RSUP Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Sumadi Lukman Anwar
- From the Doctoral Program in Medicine and Health Science, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Oncology Surgery Division, Surgery Department, RSUP Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Mohammad Rizal Chaidir
- From the Doctoral Program in Medicine and Health Science, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Hand and Microsurgery Division, Orthopedics, and Traumatology Department, Dr. Hasan Sadikin Hospital–Faculty of Medicine Padjajaran University, Bandung, Indonesia
| | - Hilmi Muhammad
- Orthopedics and Traumatology Department, RSUP Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | | | | | - A Faiz Huwaidi
- Orthopedics and Traumatology Department, RSUP Dr. Sardjito Hospital, Yogyakarta, Indonesia
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Yoneda H, Takeda S, Saeki M, Iwatsuki K, Yamamoto M, Tatebe M, Hirata H. Utility of severity scoring systems for mangled upper limb salvage: A systematic review and meta-analysis. Injury 2024; 55:111447. [PMID: 38417237 DOI: 10.1016/j.injury.2024.111447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND The purpose of scoring systems is to aid in the decision-making process of whether to salvage or amputate mangled extremities, but their efficacy for upper limbs is uncertain. In this study, we examined the predictive potential of scoring systems for upper limb salvage. METHODS Two investigators undertook a systematic search of 3 leading databases for English or Japanese literature from 1985, when the first scoring system to evaluate mangled extremities was proposed, until January 2022. To be eligible, studies must have had upper extremity limb salvage or amputation as an outcome, and identified the scoring system used and treatment outcome in individual cases. RESULTS Ten studies (N = 338) of the Mangled Extremity Scoring System (MESS) were ultimately included in the meta-analysis. The pooled sensitivity and specificity were 0.95 (95 % CI = 0.69-0.99) and 0.81 (0.65-0.91), respectively. The area under the hierarchical summary receiver operating characteristic curve was 0.95 (0.93-0.97). A subgroup analysis showed lower specificity in isolated vascular injuries. Scoring systems other than MESS were ineligible for the quantitative synthesis because none were examined in an adequate number of publications. CONCLUSION The pooled sensitivity and specificity for MESS were comparable to those reported for the lower extremities. The specificity suggests that limb salvage was achieved in at least 20 % of the patients whose MESS was above the threshold beyond which amputation is indicated. Given the likelihood of upper extremity functional limitations following amputation and the drawbacks of prostheses, we conclude that current scoring systems poorly predict salvageability of a mangled upper extremity and should not be used to justify amputation.
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Affiliation(s)
- Hidemasa Yoneda
- Department of Human Enhancement and Hand surgery, Nagoya University, Nagoya, Aichi, Japan.
| | - Shinsuke Takeda
- Orthopedic surgery of Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan
| | - Masaomi Saeki
- Department of Human Enhancement and Hand surgery, Nagoya University, Nagoya, Aichi, Japan
| | - Katsuyuki Iwatsuki
- Department of Human Enhancement and Hand surgery, Nagoya University, Nagoya, Aichi, Japan
| | - Michiro Yamamoto
- Department of Human Enhancement and Hand surgery, Nagoya University, Nagoya, Aichi, Japan
| | - Masahiro Tatebe
- Othopedic surgery of Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Hitoshi Hirata
- Department of Human Enhancement and Hand surgery, Nagoya University, Nagoya, Aichi, Japan
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Farrelly E, Tarapore R, Lindsey S, Wieland MD. Management of the Mangled Extremity. Surg Clin North Am 2024; 104:385-404. [PMID: 38453309 DOI: 10.1016/j.suc.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Mangled extremities represent one of the most challenging injuries. They indicate the need for a comprehensive trauma assessment to rule out coexisting injuries. Treatment options include amputation and attempts at limb salvage. Although both have been associated with chronic disability, new surgical techniques and evolving rehabilitation options offer hope for the future.
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Affiliation(s)
- Erin Farrelly
- Department of Orthopaedic Surgery, MedStar Orthopaedic Institute, Union Memorial Hospital, Baltimore, MD, USA.
| | - Rae Tarapore
- Department of Orthopaedic Surgery, MedStar Orthopaedic Institute, Union Memorial Hospital, Baltimore, MD, USA
| | - Sierra Lindsey
- Department of Orthopaedic Surgery, MedStar Orthopaedic Institute, Union Memorial Hospital, Baltimore, MD, USA
| | - Mark D Wieland
- Department of Orthopaedic Surgery, MedStar Orthopaedic Institute, Union Memorial Hospital, Baltimore, MD, USA
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Hsieh HH, Shieh SJ. Reconstruction With Flow-Through Chimeric Anterolateral Thigh Flap Combining Vascularized Fibular Bone Graft for Extensive Composite Tissue Defect of the Forearm: A Case Report. Ann Plast Surg 2024; 92:S65-S69. [PMID: 38170985 DOI: 10.1097/sap.0000000000003758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
ABSTRACT The management of critical limb trauma is challenging because limb salvage is preferable to amputation. For upper limb reconstruction, the surgical restoration of functionality, and appearance, a multidisciplinary approach is needed. We report the case of an extensive composite tissue defect of the forearm caused by a machine-crushing injury that was repaired by a flow-through chimeric anterolateral thigh flap with a vascularized fibular graft. Reconstruction was performed as a single-stage procedure; no complications occurred, and both functional and aesthetic outcomes were satisfactory.
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Affiliation(s)
- Hua-Hsin Hsieh
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
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Perruisseau-Carrier A, Tilhet L, Rouanet M, Henry AS, Hu W. Management of Complex Forearm Injuries: Our Strategy of Reconstruction and Clinical Results. Ann Plast Surg 2023; 90:S203-S208. [PMID: 36752518 DOI: 10.1097/sap.0000000000003390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
ABSTRACT The management of complex forearm injuries is challenging, not only because of the anatomical complexity of the region but also because of the dramatic functional consequences of these injuries. Preservation of the upper limb and restoration of hand function are the focus of the surgical management of these injuries. Decision making will consider several parameters such as the type of injury, the patient, the moment of reconstruction, the debridement, and the options available for reconstruction.A multidisciplinary approach joining plastic surgeons and orthopedic surgeons in a team effort is essential to achieve the best outcomes. On the basis of their experience, the authors conclude that the keystone in complex forearm injuries management is represented by a careful assessment of the lesions, an aggressive and early debridement, the prevention of complications such as infection and compartment syndrome, and an "as early as possible" reconstruction.
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Affiliation(s)
| | - Laura Tilhet
- From the Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Brest University Hospital, Brest, France
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Management of the Mangled Extremity. CURRENT SURGERY REPORTS 2023. [DOI: 10.1007/s40137-023-00349-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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Ponomarenko OV, Pysanko VV, Mialkovskyi DS, Tkachuk DV. THE MANAGEMENT OF THE VICTIMS WITH GUNSHOT WOUNDS OF THE EXTREMITIES WITH EXTENSIVE DEFECTS OF THE SOFT TISSUES AT THE LEVEL OF QUALIFIED MEDICAL CARE. CASE-SERIES. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1227-1232. [PMID: 37364077 DOI: 10.36740/wlek202305214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE The aim: To highlight the original experience of diagnosis and treatment of patients with gunshot wounds of the extremities with extensive defects of the soft tissues. PATIENTS AND METHODS Materials and methods: The total number of treated patients with massive gunshot wounds from February 2022 to March 2023 was 60 males. Basic labo¬ratory tests, X-rays of the affected limbs were performed to all patients. USS of the vessels with color Doppler was performed to those casualties who had no peripheral pulses on the wounded extremity. All injured persons underwent wound debridement and fasciotomy on the day of admission, 8 more casualties underwent surgical interventions on the major vessels and nerves. RESULTS Results: Good treatment outcomes for patients with extensive soft tissue injury were achieved by early surgical intervention to remove non-viable tissue. Limb preservation was achieved in 98.3% of cases. CONCLUSION Conclusions: The study's conclusion emphasizes the importance of a multidisciplinary approach to treating patients with gunshot wounds to the limbs with extensive soft tissue injury. Early surgical interventions with the removal of non-viable tissues are necessary for good outcomes. Revascularization of the affected limb is essential in case of major vessel injury if there is no thread to the life.
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Affiliation(s)
- Olena V Ponomarenko
- ZAPORIZHZHIA STATE MEDICAL AND PHARMACEUTICAL UNIVERSITY, ZAPORIZHZHIA, UKRAINE
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