The treatment of soft tissue defects of the lower leg after traumatic open tibial fracture—comment

The treatment of soft tissue defects of the lower leg after traumatic open tibial fracture—comment Eur J Plast Surg (2010) 33:309 DOI 10.1007/s00238-010-0467-8 LETTER TO THE EDITOR The treatment of soft tissue defects of the lower leg after traumatic open tibial fracture—comment Andrew G. Batchelor Received: 14 June 2010 /Accepted: 16 June 2010 /Published online: 27 July 2010 Springer-Verlag 2010 Sir, linear relationship between time of repair and the important I read the above paper with interest. Unfortunately, because complications of delayed union, nonunion and infection. of relatively small numbers and a heterogenous group of That is a hard-learned lesson and could almost be described patients, despite this representing a large body of work on as an "inconvenient truth" when it comes to designing which the authors should be commended, I feel that trauma services and organisation and its impact on important messages are being lost. This may lead the surgeons' lifestyles. inexperienced surgeon to persist with mistakes in manage- I feel that osteomyelitis is a separate and difficult ment that have dogged the improvement of trauma out- problem in its own right. As such, observations about its comes for three decades. successful management, which is largely about adequate The grade of trauma is significant. It is well recognised debridement and manipulation of blood supply [2], should that the energy transfer at the point of trauma is a major not be used to inform management decisions in the acute factor in determining management choices and success. We trauma setting. should not draw conclusions from a group that lumps together all Gustillo grades. Gustillo, in his various writing, References points out the importance of the grading in determining management choices and outcomes. 1. Gopal S, Majumder S, Batchelor AG, Knight SL, De Boer P, Smith I was saddened by the conclusion that timing is RM (2000) Fix and flap: the radical orthopaedic and plastic treatment unimportant and feel that this, too, has been drawn because of severe open fractures of the tibia. J Bone Joint Surg Br 82b:959 of the flawed nature of the study. [1] showed, quite clearly, 2. Smith I, Batchelor AG (2006) The treatment of chronic osteomy- in a large, pure series of Gustillo III fractures that there is a elitis: a 10 year audit. Br J Plast Surg 59:11 A. G. Batchelor (*) Spire Hospital, Jackson Avenue, Leeds LS8 1NT, UK e-mail: European Journal of Plastic Surgery Springer Journals

The treatment of soft tissue defects of the lower leg after traumatic open tibial fracture—comment

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Medicine & Public Health; Plastic Surgery
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