A review of forty five XXXX covered with free flaps. Analysis of complications, microbiology and prognostic factors.

@entity1 @entity2261 @entity2176 @entity115 @entity174 @entity4422 @entity1912 @entity2348 @entity2889 @entity281 @entity581 @entity130
PURPOSE: Treatment of @entity4422 is complex and controversial. The purpose of the present study is to add evidence to the management of @entity4422 , where tissue loss necessitates cover with a free @entity1912 . We identified factors that increase the risk of complications. We questioned whether early @entity1912 coverage improved the clinical outcome and whether we could improve our antibiotic treatment of @entity4422 . METHODS: From 2002 to 2013 we treated 56 @entity1 with an open @entity174 covered with a free @entity1912 . We reviewed @entity1 records and databases for type of @entity130 , smoking, time to tissue cover, @entity281 , amputations, @entity1912 loss and union of @entity174 . We identified factors that increase the risk of complications. We analysed the organisms cultured from @entity4422 to propose the optimal antibiotic prophylaxis. Follow-up was a minimum of one  year. Primary outcome was @entity2348 pattern, amputation, @entity1912 failure and union of the @entity174 . RESULTS: When soft tissue cover was delayed beyond seven  days, @entity281 rate increased from 27 to 60  % (p   <   0.04). High-energy @entity130 @entity1 had a higher risk of amputation, @entity281 , @entity1912 failure and non-union. Smokers had a higher risk of non-union and @entity1912 failure. The bacteria found were often resistant to @entity2261 , @entity581 or @entity115 , but sensitive to @entity2176 or @entity2889 . CONCLUSION: @entity1912 cover within one  week is essential to avoid @entity281 . High-energy @entity130 and smoking are important predictors of complications. We suggest antibiotic prophylaxis with @entity2176 and @entity2889 until the wound is covered in these complex injuries.
