Immediate Versus Late Flap Coverage for Traumatic Soft Tissue Defects of Lower Extremity: A Comparative Observational Study

Vishal Patil; Bhaskar Sarkar; Mohd Altaf Mir; Quamar Azam; Madhur Uniyal; Ajay Kumar; Vishal Mago; Nilesh Jagne; Divakar Goyal; Rajesh Maurya

doi:10.7759/cureus.22800

Immediate Versus Late Flap Coverage for Traumatic Soft Tissue Defects of Lower Extremity: A Comparative Observational Study

Cureus. 2022 Mar 3;14(3):e22800. doi: 10.7759/cureus.22800. eCollection 2022 Mar.

Authors

Affiliations

¹ Trauma Surgery and Critical care, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.
² Trauma Surgery and Critical Care, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.
³ Burns and Plastic Surgery, All India Institute of Medical Sciences, Bathinda, Bathinda, IND.
⁴ Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.

Abstract

Background The lower extremity trauma in patients often gets operated on late for the wound coverage and is associated with more health costs and other resources. Therefore, this study has been conducted to compare the outcome in terms of flap survival, complication rates, and hospital stay between immediate and late flap coverage of lower extremity traumatic wounds. Methods The comparative analysis of outcome is done in terms of flap survival, complication rates, and hospital stay after immediate and late flap coverage of 25 (n = 25) patients of lower extremity traumatic wounds in each group. The patients were observed, and data obtained were tabulated in a Microsoft Excel spreadsheet. The statistical analysis was done using IBM SPSS (V26.0, IBM Corporation, Armonk, NY, USA) statistical software. The chi-square test was used for descriptive data and the student's unpaired t-test for discrete-continuous data analysis. The p-value of less than 0.05 is considered significant. Results The mean defect size with SD in the immediate flap cover group is 54.5 ± 29.5 cm2, while in the late flap cover group, it is 85 ± 65 cm2 with a significant p-value of 0.0378. The mean flap size with SD in the immediate flap coverage group is 70.5 ± 34.5 cm2, while in the late flap coverage group, it is 117 ± 87.5 cm2, and the difference is statistically significant. The mean hospital stay with SD in the immediate flap coverage group is 7.5 ± 2.5 days. In contrast, in the late flap coverage group, it is 29.5 ± 8.5 days, and the difference is statistically very significant. Conclusion There are equivalent results in patients undergoing immediate and late flap coverage for the traumatic soft tissue defects of the lower extremity. There is a significant decrease in the hospital stay after immediate flap reconstruction, which subsequently reduces both direct and indirect health costs. However, there is a larger size flap requirement in cases of immediate lower extremity wound coverage.

Keywords: extremity injury; flap coverage; immediate reconstruction; late reconstruction; lower limb trauma.