{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T22:43:17Z","timestamp":1747089797787},"reference-count":31,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Limb-threatening lower extremity injuries often require secondary bone grafting after soft tissue reconstruction. We hypothesized that there would be fewer wound complications when performing secondary bone grafting via a remote surgical approach rather than direct flap elevation.<\/jats:p><jats:p>\n          Methods\u2003A retrospective cohort study was performed at a single Level 1 trauma center comparing complications after secondary bone grafting in patients who had undergone previous soft tissue reconstruction after open tibia fractures between 2006 and 2020. Comparing bone grafting via a remote surgical incision versus direct flap elevation, we evaluated wound dehiscence requiring return to the operating room as the primary outcome. Secondary outcomes were deep infection and delayed amputation.<\/jats:p><jats:p>\n          Results\u2003We identified 129 patients (mean age: 40 years, 82% male) with 159 secondary bone grafting procedures. Secondary bone grafting was performed via a remote surgical approach in 54% (n\u2009=\u200986) and direct flap elevation in 46% (n\u2009=\u200973) of cases. Wound dehiscence requiring return to the operating room occurred in one patient in the flap elevation group (1%) and none of the patients in the remote surgical approach. The odds of deep wound infection (OR, 1.77; p\u2009=\u20090.31) or amputation (OR, 1.43; p\u2009=\u20090.73) did not significantly differ between surgical approaches. No significant differences were found in complications between the reconstructive surgeon elevating and re-insetting the flap and the orthopaedic trauma surgeon performing the flap elevation and re-inset.<\/jats:p><jats:p>\n          Conclusion\u2003Direct flap elevation for secondary bone grafting after soft tissue reconstruction for open tibia fractures did not result in more complications than bone grafting via a remote surgical approach. These findings should reassure surgeons to allow other clinical factors to influence the surgical approach for bone grafting.<\/jats:p>","DOI":"10.1055\/s-0043-1768219","type":"journal-article","created":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T19:12:14Z","timestamp":1682536334000},"page":"059-069","source":"Crossref","is-referenced-by-count":2,"title":["Secondary Bony Defects after Soft Tissue Reconstruction in Limb-Threatening Lower Extremity Injuries: Does the Approach to Flap Elevation Matter?"],"prefix":"10.1055","volume":"40","author":[{"given":"Cynthia E.","family":"Burke","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lily R.","family":"Mundy","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jayesh","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison L.","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Blessing","family":"Enobun","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan N.","family":"O'Hara","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdulai","family":"Bangura","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine C.","family":"O'Connor","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julio J.","family":"Jauregui","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan F.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert V.","family":"O'Toole","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raymond A.","family":"Pensy","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,4,26]]},"reference":[{"issue":"04","key":"ref1","first-page":"641","article-title":"Factors influencing the decision to amputate or reconstruct after high-energy lower extremity trauma","volume":"52","author":"E J MacKenzie","year":"2002","journal-title":"J Trauma"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1097\/01.ta.0000195985.56153.68","article-title":"Early predictors of long-term work disability after major limb trauma","volume":"61","author":"E J MacKenzie","year":"2006","journal-title":"J Trauma"},{"issue":"09","key":"ref3","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.2106\/00004623-200309000-00006","article-title":"Psychological distress associated with severe lower-limb injury","volume":"85","author":"M L McCarthy","year":"2003","journal-title":"J Bone Joint Surg Am"},{"issue":"230","key":"ref4","first-page":"98","article-title":"Severe open tibial fractures. 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