Outcomes of Tissue Reconstruction in Distal Lower Leg Fractures: a Retrospective Cohort Study

Background:Open and closed fractures can be associated with posttraumatic or postoperative soft tissue defects caused by initial trauma, operative procedures or infections. This study evaluated the outcomes of postoperative qualities ofpatients with open or closed lower leg fractures,related softtissue defects, and subsequent flap coverage.Methods:We performed a retrospective single-center cohort study in a level 1 trauma center. We analyzed thepatients treated fromJanuary 2012 through December 2017 and recorded demographics, treatment, and outcome data.The outcome data were measured via patient-reported Foot and Ankle Outcomes Scores (FAOS) and EQ-5D-5L scores.Results: We included 22 patients with complicated fractures (11 open and 11 closed) and subsequent softtissue defects and flap coverages. The mean follow-up time was 41.2 months. Twenty-onepatients developed infections, and necrosis at the site of surgery manifested in all closed fractures. Therefore, all patients needed soft tissue reconstructions. Preoperatively, 16patients underwent arterial examinations via angiography and sixunderwent ultrasound examinations of the venous system. Ten patients had complications involving the flaps due to ischemia and consequent necrosis. The mean EQ-5D index was 0.62 ± 0.27, EQ-5DVAS score was 57.7 ± 20.2. The mean FAOS was 60.7 ± 22.2; in particular,quality of life was 32.3± 28.8. The rate of returning to work in our patient groupwas 37.5% after one year.Conclusions:Distal tibial fracturesoften require revisions and soft tissue reconstruction. The evaluated patient population had poor outcomes in terms of function, quality of life and return to work. Our results imply that the severity of associated soft tissue damage with many revision operations and flap complications lead to a poorer outcome with respect to patients without flap ischemia.