Improving reemployment rates after limb salvage of acute severe tibial fractures by microvascular soft-tissue reconstruction.

Patients with severe open tibial fractures may have a low rate of reemployment after reconstruction. Sixty-five limb-salvage patients were followed for at least 2 years to determine the factors that influence future employment. The preinjury conditions found to influence reemployment included age less than 40, higher education, and white-collar employment. Early postinjury reconstruction and established bone continuity are advantageous to the patient, and the likelihood of reemployment is improved. Reconstructive surgeons may improve employment rates by early soft-tissue coverage, bone grafting (immediate cancellous or free bone transfers), and complete healing. Ambulation follows if bone continuity is established early, and the patient has gained an early advantage on the way to employment and a purposeful future. The reemployment rate has improved to 67 percent in the 15 limb-salvage patients reconstructed after the initiation of aggressive intervention by the reconstructive surgeon. This equals the reemployment rate of traumatic below-knee amputees previously reported.