|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
Selection and design of the reconstruction are then made. The size and location of the defect, as well as the need for skin, subcutaneous tissue, and bone, contribute to the reconstructive selection, and consideration may also be given to specific motor and sensory deficits.
The reconstruction is then performed with antibiotic coverage based on cultures taken during debridement. Selection of recipient vessels is based on arteriography and intraoperative examination. Vein grafts are promptly used to avoid reliance on grossly fibrotic vessels.
Postoperative antibiotic therapy is generally limited to 7 to 10 days, and the patient is usually ready for discharge at that time. Cases of long-established osteomyelitis, however, are still treated with 4 to 6 weeks of intravenous antibiotics. Thorough resection of infected bone before free tissue coverage may make this length of antibiotic treatment excessive, but we currently lack the data necessary to advocate shorter course of therapy. Postoperative protection of the transferred tissue includes preventing prolonged dependence, exposure to cold, and nicotine exposure for at least 6 weeks.
This technique of wound closure has resulted in a high flap survival rate (93%) and few immediate infectious complications.l7 We have yet to analyze thoroughly the long-term results of our reconstructed complex wounds, but we expect this analysis to define the long-term efficacy of these reconstructions.
1. Urbaniak, J.R., and Richards, R.R.: Complications in microvascular surgery. In Complications in Orthopedic Surgery. Edited by C.H. Epps. Philadelphia, J.B. Lippincott, 1986.
2. Valauri, F., and Buncke. H.J.: Digital and upper extremity replantation. In The Hand. Vol III. Edited by R. Tubiana. Philadelphia, W.B. Saunders, 1988.
3. Gustilo, R.B., and Anderson, J.T.: Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones. J. Bone Joint Surg. 58A:453, 1976.
4. Mathes, S.J.: The muscle flap for management of osteomyelitis. N. Engl. J. Med. 306:294, 1982.
5. Monson, T.P., and Nelson, C.L.: Microbiology for orthopaedic surgeons. Clin. Orthop. 190:14, 1984.
6. Blatz, D.J.: Open fracture of the tibia and fibular complicated by infection with Aeromonas hydrophila. J. Bone Joint Surg. 61A:790, 1979.
7. Smith, J.A.: Aeromonas hydrophila: analysis of 11 cases. Can: Med. Assoc. J. 122:1270, 1980.
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