The Impact of Inadequate Soft-tissue Coverage following Severe Open Tibia Fractures in Tanzania

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The Impact of Inadequate Soft-tissue Coverage following Severe Open Tibia Fractures in Tanzania


JournalPlastic and Reconstructive Surgery – Global Open
Article typeJournal research article – Clinical research
Publication date – Dec – 2020
Authors – Jordan T. Holler, Madeline C. MacKechnie, Patrick D. Albright, Saam Morshed, David W. Shearer, Michael J. Terry
KeywordsOpen Tibia Fractures, Soft-tissue Coverage, Tanzania
Open access – Yes
SpecialityTrauma and orthopaedic surgery
World region Eastern Africa
Country: Tanzania
Language – English
Submitted to the One Surgery Index on December 26, 2020 at 4:10 pm
Abstract:

Background:
Managing lower extremity fractures complicated by large soft-tissue defects is challenging for surgeons in low- and middle-income countries, and long-term quality of life (QOL) for these patients is unclear.

Methods:
We examined QOL, surgical complications, and longitudinal outcomes in 10 patients with Gustilo-Anderson Classification Type IIIB open tibia fractures seen at an orthopedic institute in Tanzania, from December 2015 to March 2017. Patients completed follow-up at 2-, 6-, 12-, 26-, and 52-week time points, and returned for qualitative interviews at 2.5 years. The primary outcome was QOL, as measured using EuroQoL-5D scores and qualitative semi-structured interview responses. The secondary outcome was rate of complication, as defined by reoperation for deep infection or nonunion.

Results:
Ten patients enrolled in the study and 7 completed 1-year follow-up. All fractures were caused by road traffic accidents and treated by external fixation. No patients received initial soft-tissue (flap) coverage of the wound. All patients developed an infected nonunion. No patients returned to work at 6 weeks, 3 months, or 6 months. EQ-5D index scores at 1 year were poor (0.71 ± 0.09). Interview themes included ongoing medical complications, loss of employment, reduced income, and difficulty with activities of daily living.

Conclusions:
Patients in low- and middle-income countries with IIIB open tibia fractures not treated with appropriate soft-tissue coverage experience poor QOL, high complication rates, and severe socioeconomic effects as a result of their injuries. These findings illustrate the need for resources and training to build capacity for extremity soft-tissue reconstruction in LMICs.

OSI Number – 20818

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