In fracture-related infection, postoperative wound care will depend on the type of reconstruction that has been performed (direct closure, skin graft, pedicled flap, free flap). Free flaps require postoperative monitoring to detect a possible microvascular failure that requires early revision for flap salvage. Flaps can be monitored using many methods. The most common one is clinical examination, aided or not by Doppler auscultation. However, the subjectivity and user-dependency of these modalities has led teams to look for other ways of monitoring flaps, such as using color duplex ultrasound, flow Coupler, near-infrared spectroscopy, the implantable Doppler, and infrared thermography. In the event of flap failure, it is imperative to detect the cause of the failure and identify any factors that could negatively affect flap viability (especially if they are modifiable) before planning another reconstruction technique, whether it is another free flap or not. Prolonged immobilization leads to decreased joint range of motion and weakness, so physical therapy is another important aspect of postoperative care. Initiation of limb motion and weight-bearing will depend on where the fracture is located, the stability of the construct and which surgical technique has been used for reconstruction.

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Fine-Tuning Postoperative Care of Fracture-Related Infection

  • Elena Armas,
  • Nieves Vanaclocha

摘要

In fracture-related infection, postoperative wound care will depend on the type of reconstruction that has been performed (direct closure, skin graft, pedicled flap, free flap). Free flaps require postoperative monitoring to detect a possible microvascular failure that requires early revision for flap salvage. Flaps can be monitored using many methods. The most common one is clinical examination, aided or not by Doppler auscultation. However, the subjectivity and user-dependency of these modalities has led teams to look for other ways of monitoring flaps, such as using color duplex ultrasound, flow Coupler, near-infrared spectroscopy, the implantable Doppler, and infrared thermography. In the event of flap failure, it is imperative to detect the cause of the failure and identify any factors that could negatively affect flap viability (especially if they are modifiable) before planning another reconstruction technique, whether it is another free flap or not. Prolonged immobilization leads to decreased joint range of motion and weakness, so physical therapy is another important aspect of postoperative care. Initiation of limb motion and weight-bearing will depend on where the fracture is located, the stability of the construct and which surgical technique has been used for reconstruction.