Abstract：
OBJECTIVE: Crush injuries and open fractures are often accompanied by extensive tissue loss, rendering clinical and surgical management quite challenging, particularly in the upper extremities. The primary goal in these cases is to obtain a functional and cosmetically acceptable limb. However, the management of complex crush injuries (involving extensive tissue loss and open fractures) is associated with a variety of complications, ranging from infection to amputation. In this study, we aimed to analyze the clinical outcomes of reconstruction for managing complex upper extremity crush injuries.
METHODS: We reviewed the clinical and surgical data of patients with complex upper extremity crush injuries who were treated at five Level III trauma centers between July 2012 and December 2022. Patients with an injury that could not be replanted at the time of trauma, those who succumbed to the injuries before reconstruction, and patients with a postoperative follow-up time of < 1-year, missing data, or lost to follow-up were excluded. Data regarding demographic characteristics, clinical examination, radiological images, mechanism of injury, orthopedic or non-orthopedic injuries, comorbidities, tissue loss size, surgical procedures, number of debridement and first debridement time, complications, number of days of hospitalization and, if any, intensive care unit stay, were recorded.
RESULTS: Twenty-one patients were included in the study (mean age = 37.4 ± 7.25; range = 16-62 years; 17 males, 4 females). Road traffic accidents were the most frequently documented cause of injury. The mean time to the first reconstruction was 4.2 ± 1.2 days. Tissue defect sizes ranged from 6 × 4 cm to 18 × 12 cm. Anterolateral thigh flaps, latissimus dorsi flaps, radial forearm, and lateral arm flaps, with sizes ranging from 3 × 6 cm to 18 × 26 cm, were used in the patients.
CONCLUSIONS: Simple reconstruction techniques, such as skin grafts or island flaps, can provide satisfactory results in terms of both appearance and function in upper extremity crush injuries with significant bone exposure and large soft tissue defects.
METHODS: We reviewed the clinical and surgical data of patients with complex upper extremity crush injuries who were treated at five Level III trauma centers between July 2012 and December 2022. Patients with an injury that could not be replanted at the time of trauma, those who succumbed to the injuries before reconstruction, and patients with a postoperative follow-up time of < 1-year, missing data, or lost to follow-up were excluded. Data regarding demographic characteristics, clinical examination, radiological images, mechanism of injury, orthopedic or non-orthopedic injuries, comorbidities, tissue loss size, surgical procedures, number of debridement and first debridement time, complications, number of days of hospitalization and, if any, intensive care unit stay, were recorded.
RESULTS: Twenty-one patients were included in the study (mean age = 37.4 ± 7.25; range = 16-62 years; 17 males, 4 females). Road traffic accidents were the most frequently documented cause of injury. The mean time to the first reconstruction was 4.2 ± 1.2 days. Tissue defect sizes ranged from 6 × 4 cm to 18 × 12 cm. Anterolateral thigh flaps, latissimus dorsi flaps, radial forearm, and lateral arm flaps, with sizes ranging from 3 × 6 cm to 18 × 26 cm, were used in the patients.
CONCLUSIONS: Simple reconstruction techniques, such as skin grafts or island flaps, can provide satisfactory results in terms of both appearance and function in upper extremity crush injuries with significant bone exposure and large soft tissue defects.
摘要：
目的：挤压伤和开放性骨折常伴有广泛的组织丢失，使临床和外科管理相当具有挑战性，特别是在上肢。在这些情况下的主要目标是获得功能性和美容上可接受的肢体。然而,复杂的挤压伤（包括广泛的组织丢失和开放性骨折）的处理与各种并发症有关，从感染到截肢。在这项研究中,我们旨在分析重建治疗复杂上肢挤压伤的临床结果。
方法：我们回顾了2012年7月至2022年12月在五个III级创伤中心接受治疗的复杂上肢挤压伤患者的临床和手术数据。受伤时无法重新种植的患者，那些在重建前受伤的人，术后随访时间<1年的患者，缺少数据，或失去随访被排除。有关人口特征的数据，临床检查,放射学图像，损伤机制,骨科或非骨科损伤，合并症,组织损失大小，外科手术,清创次数和首次清创时间，并发症,住院天数和，如果有的话,重症监护室逗留,被记录下来。
结果：21名患者被纳入研究（平均年龄=37.4±7.25；范围=16-62岁；17名男性，4个女性）。道路交通事故是最常见的伤害原因。首次重建的平均时间为4.2±1.2天。组织缺损大小6×4～18×12cm。股前外侧皮瓣,背阔肌皮瓣,前臂桡骨,和侧臂皮瓣，尺寸从3×6厘米到18×26厘米，用于患者。
结论：简单的重建技术，如植皮或岛状皮瓣，在上肢挤压伤具有明显的骨暴露和较大的软组织缺损的外观和功能方面均可提供令人满意的结果。
方法：我们回顾了2012年7月至2022年12月在五个III级创伤中心接受治疗的复杂上肢挤压伤患者的临床和手术数据。受伤时无法重新种植的患者，那些在重建前受伤的人，术后随访时间<1年的患者，缺少数据，或失去随访被排除。有关人口特征的数据，临床检查,放射学图像，损伤机制,骨科或非骨科损伤，合并症,组织损失大小，外科手术,清创次数和首次清创时间，并发症,住院天数和，如果有的话,重症监护室逗留,被记录下来。
结果：21名患者被纳入研究（平均年龄=37.4±7.25；范围=16-62岁；17名男性，4个女性）。道路交通事故是最常见的伤害原因。首次重建的平均时间为4.2±1.2天。组织缺损大小6×4～18×12cm。股前外侧皮瓣,背阔肌皮瓣,前臂桡骨,和侧臂皮瓣，尺寸从3×6厘米到18×26厘米，用于患者。
结论：简单的重建技术，如植皮或岛状皮瓣，在上肢挤压伤具有明显的骨暴露和较大的软组织缺损的外观和功能方面均可提供令人满意的结果。
