Soft Tissue Reconstruction and Salvage of Infected Fixation Hardware | Dr. Daniel Gould

Dr. Daniel Gould co-authored this research published in Plastic and Reconstructive Surgery Global Open, examining whether infected internal fixation hardware can be successfully retained during reconstruction of complex lower extremity injuries. 

Infection following surgical fixation of a tibial fracture can create a significant reconstructive challenge. While removing infected hardware may sometimes be necessary, doing so is not always feasible. In selected cases, surgeons may instead attempt to control the infection while preserving the fixation needed for the bone to heal.

The researchers reviewed patients with tibial fractures requiring soft tissue reconstruction at a Level I trauma center between 2007 and 2015. Twenty-five patients underwent reconstruction in an effort to preserve infected internal fixation hardware. 

Treatment involved a combination of surgical debridement, antibiotics, and soft tissue coverage. Local flaps were used in 60% of cases, while the remaining 40% required free flap reconstruction to provide healthy tissue coverage over the injured area and hardware. 

At an average follow-up of approximately 16 months, 76% of patients achieved clinical suppression of the infection, while 96% achieved successful limb salvage. More than half also achieved bony union, with only one patient ultimately requiring amputation because of recurrent infection. 

The research demonstrates that, in appropriately selected patients, soft tissue reconstruction can play an important role in managing infected fixation hardware while preserving both the injured limb and the stability required for fracture healing.