Aim: To review the service that we provide for complex lower limb trauma and compare with published international standards
Method: Retrospective review of all cases requiring free flap coverage at Middlemore Hospital over 6 years from June 2014-2020. Clinical notes were reviewed from electronic records.
Results: 58 patients received acute free flap coverage for compound lower limb fractures. 37 of these patients were transferred to Middlemore from other DHB’s. The median length of time from injury to hospital transfer was 4 days. 2 patients received free flap coverage within 72 hours, 23 patients (40%) within 7 days. Median time for all patients from date of injury to flap coverage was 9 days. The median time from definitive orthopaedic treatment to flap coverage was 1 day. The median length of time from referral to Plastic Surgery services and flap coverage was 5 days. 2 patients had flap loss, 16 patients (28%) had complications with deep infection, 5 patients (8.6%) had secondary amputations. For those who have completed their reconstruction the median time to full weight-bearing status with limited pain was 334 days.
Discussion: Our service does not meet the current recommendations outlined by the BAPRAS and BOA for management of severe open lower limb fractures. We plan to discuss these shortfalls within our service and establish ways to improve care for our patients.