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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT06293469
Registration number
NCT06293469
Ethics application status
Date submitted
28/02/2024
Date registered
5/03/2024
Date last updated
17/07/2024
Titles & IDs
Public title
Accelerated Flap Coverage in Severe Lower Extremity Trauma
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Scientific title
Accelerated Flap Coverage Versus Standard Timing in the Treatment of Severe Lower Extremity Musculoskeletal Injuries
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Secondary ID [1]
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IRB00434587
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Universal Trial Number (UTN)
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Trial acronym
FLAP ATTACK
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Open Tibia Fracture
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Open Dislocation of Ankle
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Extremity Fracture Lower
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Extremity Injuries Lower
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Condition category
Condition code
Injuries and Accidents
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Fractures
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Musculoskeletal
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Other muscular and skeletal disorders
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Injuries and Accidents
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0
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Other injuries and accidents
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Surgery - Accelerated Flap Coverage Surgery
Treatment: Surgery - Standard of Care Flap Timing
Experimental: Accelerated Flap Coverage - Accelerated flap surgery timing at a goal of within 72 hours from injury. Management of the fracture or dislocation, selection of flap, and post-injury flap management will be at the discretion of the operating surgeons and documented for both treatment groups.
Active comparator: Standard of Care Flap Timing - The flap surgery will be performed at the standard of care timing for the institution. Management of the fracture or dislocation, selection of flap, and post-injury flap management will be at the discretion of the operating surgeons and documented for both treatment groups.
Treatment: Surgery: Accelerated Flap Coverage Surgery
Timing of the flap surgery is with a goal of 72 hours from injury
Treatment: Surgery: Standard of Care Flap Timing
Timing of the flap surgery is the standard of care flap timing for the participating institution.
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Intervention code [1]
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Treatment: Surgery
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Clinical status
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Assessment method [1]
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Clinical status is a hierarchical composite of the following outcomes:
1. All-cause mortality
2. Amputation related to injury
3. Re-operation for infection and/or flap complication (flap compromise, partial and/or complete flap failure)
4. Days in hospital, defined as days in an acute in-patient hospital (i.e., not rehab or nursing facility)
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Timepoint [1]
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6 months
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Secondary outcome [1]
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Mortality
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Assessment method [1]
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All-cause mortality
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Timepoint [1]
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6 months and 12 months
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Secondary outcome [2]
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Amputation
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Assessment method [2]
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Amputation related to injury. Amputation will be time-to-event, with the assumption that earlier is worse than later.
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Timepoint [2]
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6 months and 12 months
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Secondary outcome [3]
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Unplanned re-operation
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Assessment method [3]
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Unplanned re-operation for infection and/or flap complication (flap compromise, partial and/or complete flap failure). Re-operation for infection and flap complication will be time-to-event, with the assumption that earlier is worse than later. Re-operation for infection and major flap complication will account for more than one operation, assuming that more operations are worse.
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Timepoint [3]
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6 months and 12 months
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Secondary outcome [4]
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Number of days in hospital
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Assessment method [4]
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Days in an acute in-patient hospital (i.e., not rehab or nursing facility)
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Timepoint [4]
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6 months and 12 months
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Secondary outcome [5]
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Quality of life as assessed by the Limb-Q
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Assessment method [5]
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Health-related quality of life and patient satisfaction measured with the Limb-Q. The Limb-Q is a set of independently functioning scales. All scales are scored 0-100 (higher = better). The Limb-Q Appearance, Physical, Symptoms, Financial Impact, Life Impact, and Psychological scales will be used.
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Timepoint [5]
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6 months and 12 months
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Eligibility
Key inclusion criteria
The inclusion criteria are:
1. Patients 18 years of age or older.
2. Severe lower extremity open fracture and/or dislocation below the knee requiring an acute flap for management of the musculoskeletal injury.
3. Will have all planned flap surgeries performed by a participating surgeon or delegate.
4. Able to be randomized within 48 hours of injury.
The exclusion criteria are:
1. Site is unable to implement the accelerated flap protocol due to local logistics.
2. Primary amputation anticipated prior to attempted flap for management of the injury.
3. Critical limb ischemia that requires re-vascularization for limb perfusion.
4. Chronic or acute infection at or near the musculoskeletal injury site at the time of initial injury surgery.
5. Burns at the musculoskeletal injury site.
6. Incarceration.
7. Currently enrolled in a trial that does not permit co-enrollment.
8. Declined to provide informed consent.
9. Unable to obtain informed consent due to language barriers.
10. Unable to obtain informed consent because a legally authorized representative was unavailable.
11. Anticipated problems, in the judgment of research personnel, with maintaining follow-up with the patient.
12. Prior enrollment in the trial.
13. Other reason to exclude the patient, as approved by the Methods Centre.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
NA
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
1/10/2024
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
1/02/2030
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Actual
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Sample size
Target
356
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
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The Alfred Hospital - Melbourne
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Recruitment postcode(s) [1]
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3004 - Melbourne
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Recruitment outside Australia
Country [1]
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United States of America
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State/province [1]
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California
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Country [2]
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United States of America
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State/province [2]
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Maryland
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Country [3]
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United States of America
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State/province [3]
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Oregon
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Country [4]
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United States of America
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State/province [4]
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Tennessee
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Country [5]
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Spain
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State/province [5]
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Barcelona
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Funding & Sponsors
Primary sponsor type
Other
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Name
Johns Hopkins University
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Address
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Country
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Other collaborator category [1]
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Other
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Name [1]
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McMaster University
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Address [1]
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Country [1]
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Other collaborator category [2]
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Other
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Name [2]
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University of Maryland, Baltimore
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Address [2]
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Country [2]
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Other collaborator category [3]
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Other
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Name [3]
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Orthopaedic Trauma Association
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Address [3]
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Country [3]
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Other collaborator category [4]
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Other
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Name [4]
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Foundation of Orthopedic Trauma
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Address [4]
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Country [4]
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Ethics approval
Ethics application status
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Summary
Brief summary
The goal of this randomized controlled trial is to determine if accelerated flap coverage compared to standard flap coverage timing leads to improved infection-related complications in patients with open fractures and/or dislocations below the knee. Eligible patients will be randomized to receive either a flap within a goal of 72 hours of injury or standard of care flap timing for the institution. The primary outcome will be a composite outcome to evaluate clinical status 6 months after randomization. Components of the composite outcome will be hierarchically assessed in the following order: 1) all-cause mortality, 2) amputation related to injury, 3) re-operation for infection and/or flap complication (flap compromise, partial and/or complete flap failure), and 4) days in hospital, defined as days in an acute in-patient hospital (i.e., not rehab or nursing facility).
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Trial website
https://clinicaltrials.gov/study/NCT06293469
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Lily Mundy, MD
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Address
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Johns Hopkins School of Medicine
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Lily Mundy, MD
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Address
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Country
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Phone
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410-706-2492
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Fax
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Email
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[email protected]
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Contact person for scientific queries
No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT06293469
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