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Does Vascular Injury Affect the Outcome of Open Tibial Fractures?

Chummun, Shaheel M.R.C.S.; Wigglesworth, Thomas A. M.B.Ch.B.; Young, Katie; Healey, Beth; Wright, Thomas C. F.R.C.S.(Plast.); Chapman, Thomas W. L. F.R.C.S.(Plast.); Khan, Umraz F.R.C.S., F.R.C.S.(Plast.), F.C.P.S.(Hon.)

Plastic and Reconstructive Surgery: February 2013 - Volume 131 - Issue 2 - p 303–309
doi: 10.1097/PRS.0b013e3182789bcf
Reconstructive: Lower Extremity: Original Articles
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Background: Consensus on the definition of a Gustilo grade IIIC injury was sought, and the influence of vascular injuries on outcome of severe open tibial fractures was investigated.

Methods: Three thousand three hundred fifty-one plastic and orthopedic surgeons were sent questionnaires to determine their interpretation of Gustilo grade IIIC injuries. Notes of patients with severe open tibial injuries reconstructed at Frenchay orthoplastic center with free tissue transfer between 2006 and 2010 were reviewed. Data were collected on patient demographics and vascular integrity. Outcome was measured using the Enneking score.

Results: Four hundred seventy-six plastic surgeons and 2875 orthopedic surgeons were contacted. Seven hundred fifty-three responses (22.5 percent) were received; 46.2 percent thought a grade IIIC injury was a devascularized limb, 24.2 percent felt it was a one- or two-vessel injury, 6.9 percent thought it represented any vascular injury, and 22.7 percent had no definite answer. Sixty-eight patients (50 men and 18 women; mean age, 42.7 years) were identified. Fifty had normal angiograms and 18 sustained vascular injuries. Forty-two percent of vascular injuries were to the anterior tibial artery, 37 percent were to the posterior tibial, and 27 percent were to the peroneal. Mean follow-up was 11.2 months. Mean Enneking score for patients without and with vascular injury was 29.8 and 24.4, respectively (p = 0.004).

Conclusions: Vascular injury independently influences long-term limb function. The authors suggest a modification to the current classification to improve communication among surgeons, and advocate the use of preoperative angiography before free soft-tissue reconstruction of severe open tibial fractures.


Bristol, United Kingdom

From the Department of Plastic Surgery, Frenchay Hospital, and The Medical School, University of Bristol.

Received for publication May 2, 2012; accepted August 9, 2012.

Presented at the Annual Summer Meeting of the British Association of Plastic, Reconstructive, and Aesthetic Surgeons, in Oxford, United Kingdom, July 6 through 8, 2011.

Disclosure:None of the authors has any financial disclosures that might pose or create a conflict of interest with information presented in this article. No external funds were received.

Umraz Khan, F.R.C.S., F.R.C.S.(Plast.), F.C.P.S.(Hon.); Department of Plastic Surgery, Frenchay Hospital, Bristol BS16 1LE, United Kingdom,

©2013American Society of Plastic Surgeons