Amputation primaire versus reconstruction par lambeau libre des fractures ouvertes de jambe : résultats fonctionnels et qualité de vie à long terme

Abstract : Introduction: The management of open tibial fractures remains a complex issue and continues to be an evolving debate in the field. The choice between early amputation or conservative treatment is not consensual. The main objective of this study was to compare the functional outcomes and quality of life of two groups of patients based on their initial treatment. The hypothesis was that early amputation provides better functional recovery and better quality of life compared to reconstruction. Materials and methods: All patients with Gustilo 3B or 3C open tibial fractures between January 2010 and December 2015 were included. Minimum follow-up of two years was necessary. Associated lesions, rate of complications, number of surgical procedures, rate of osteitis, initial hospital stay and the duration of follow-up were collected according to their initial treatment (primary amputation or reconstruction of the limb with free flap). Functional parameters such as chronic pain, walking distance, walking aids, work status, driving and physical agility were self-reported by patients as was the quality of life using the Short Form (SF-36). All these parameters were compared between the two groups. Results: Twenty-four patients were analyzed, thirteen in the free flap reconstruction group and eleven in the primary amputation group. Upon comparison, the rate of osteitis and number of surgical procedures carried out were significantly higher amongst the reconstruction patients group, along with follow-up time which was longer. Prolonged standing, hopping and running were better performed by the amputee patients. Other functional parameters such as pain, work life and driving were similar between the two groups. Both groups were also comparatively similar in terms of quality of life as well. However, amputee patients reported significantly better scores for physical activity and physical role functioning. Conclusion: Primary amputation in the management of severe trauma to the lower limbs appears to be a viable treatment option and must not be deemed as a failure. The decision must be made in a careful manner and should be multidisciplinary. At this point the two treatments are valid, however, the patient must be one of the main decision makers of which procedure to carry out after clear and fair information is given.
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Submitted on : Wednesday, April 3, 2019 - 4:06:29 PM
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Najib Kachouh. Amputation primaire versus reconstruction par lambeau libre des fractures ouvertes de jambe : résultats fonctionnels et qualité de vie à long terme. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02089315⟩

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