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Soft-Tissue Defects and Exposed Hardware: A Review of Indications for Soft-Tissue Reconstruction and Hardware Preservation

Viol, Anthony M.D.; Pradka, Sarah P. B.A.; Baumeister, Steffen P. M.D.; Wang, Danru M.D.; Moyer, Kurtis E. M.D.; Zura, Robert D. M.D.; Olson, Steven A. M.D.; Zenn, Michael R. M.D.; Levin, Scott L. M.D.; Erdmann, Detlev M.D., Ph.D., M.H.Sc.

Plastic and Reconstructive Surgery: April 2009 - Volume 123 - Issue 4 - p 1256-1263
doi: 10.1097/PRS.0b013e31819f2b5e
Reconstructive: Lower Extremity: Original Articles

Background: Traditionally, management of exposed hardware has included irrigation and débridement, intravenous antibiotics, and likely removal of the hardware. Increasingly, the goal of wound closure without hardware removal using plastic surgical techniques of soft-tissue reconstruction has been emphasized. Identification of parameters for retaining exposed hardware may assist surgeons with management decisions and outcomes.

Methods: A current literature review was performed to identify parameters with prognostic relevance for management of exposed hardware before soft-tissue reconstruction.

Results: The following parameters were identified as important for the potential salvage of exposed hardware with soft-tissue coverage: hardware location, infection, duration of exposure, and presence of hardware loosening.

Conclusions: Management of exposed hardware has included the removal of the hardware. However, if certain criteria are met—specifically, stable hardware, time of exposure less than 2 weeks, lack of infection, and location of hardware—salvage of the hardware with plastic surgical soft-tissue coverage may be a therapeutic option.

Durham, N.C.

From the Divisions of Plastic, Reconstructive, Maxillofacial, and Oral Surgery and Orthopedic Surgery, Department of Surgery, Duke University Medical Center.

Received for publication May 6, 2008; accepted October 14, 2008.

Presented at the 51st Annual Meeting of the Southeastern Society of Plastic and Reconstructive Surgeons, in Boca Raton, Florida, June 6 through 11, 2008.

Disclosure: None of the authors has a financial interest to declare in relation to the content of this article.

Detlev Erdmann, M.D., Ph.D., M.H.Sc.; Division of Plastic, Reconstructive, Maxillofacial, and Oral Surgery; Duke University Medical Center; Box 3181; Durham, N.C. 27710;

©2009American Society of Plastic Surgeons