Evaluation of a new system of wound irrigation and debridement (original) (raw)
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Background Due to contamination, open fractures are considered to be dangerous and thereby require proper management. Through a systematic review and meta-analysis, this study compares the literature on pre-debridement and post-debridement cultures derived from such fracture sites. Methods Data for this review was collected through various online sources such as dataBASE (EMBASE), medical literature analysis and retrieval system online (MEDLINE) and different citations provided the relevant data. Results Twenty articles were included. The desired timing to examine the debridement was six hours post-injury (according to the sixhour rule). Antibiotics including ampicillin, penicillin, cefazolin, cefuroxime, and flucloxacillin were used in some patients. The use of Ancef I as an antibiotic during the starting hours of fracture helps to reduce the chances of infection in 1.4% of the infected patients. The infection rate was 3% in pre-debridement culture, while a 2% infection rate was found in post debridement culture. Gram-negative bacteria were responsible for pre-debridement infection, while gram-positive bacteria were responsible for postdebridement. Conclusion The pre-debridement infection rates are reduced as compared to post-debridement when treatment is initiated within a strict time interval and limited to the specific use of antibiotics. Treatment of gram-negative bacteria helps to reduce the bulk of infectious material and thereby reduces the infection rate. Keywords Open fractures; Debridement; Pre-debridement; Post-debridement; Meta- analysis; Systematic review.
Medicina Moderna - Modern Medicine
Open fractures represent a challenging aspect of modern traumatology with high individual and social impact especially due to septic complications which require prolonged hospitalization, repeated surgery and considerable costs. That is why medical research is directed to establishing the most effi cient diagnostic and therapeutic algorithms able to decrease the incidence of septic complications and promote optimal fracture healing. The purpose of this paper is to underline the importance of early proper surgical debridement for the outcome of these fractures as reflected by the experience of a Level 1 Trauma Centre in order to include this aspect into future therapeutical guidelines.
VAC -Prospective Study of Management of Open Wounds in Compound Fractures
IOSR Journals , 2019
A wound is defined as an injury creating a disruption in the normal anatomical structure and function of the skin. There are two different types of wounds: vulnus that is an acute wound, which heals according to the normal wound healing process, and ulcus that is defined as hard-to-heal wounds (previously labeled chronic wounds) such as leg ulcers, pressure ulcers and diabetic foot ulcer. These wounds have duration of more than six weeks and often show a disturbed wound healing process due to underlying causes other than direct trauma. MATERIALS AND METHODS This is a prospective study. Source of study were the 40 Cases satisfying the inclusion criteria admitted in KIMS, Hubli during the study period of November 2016 to October 2018. RESULTS 40 patients visiting KIMS hospital with open fractures of Guistilo Anderson grade 3B.Wounds were initially debrided and vacuum assisted dressing applied. Wounds were assessed depending on wound size and score before and after the application of VAC and the number of VAC settings required for uniform healthy granulation tissue formation was noted. VAC Increases the local blood flow to the wound. It considerably decreases the bacterial load of the wound and thus wound infection. VAC maintains an acidic pH and low oxygen tension on the wound which promotes granulation tissue formation and angiogenesis. Negative pressure wound therapy Induces mechanical stretch on the cell cytoskeleton leading to the release of cytokines associated with wound healing. VAC also reduce wound size, accelerates granulation tissue formation and lower the coverage complexity down the 'reconstructive ladder' when applied as a temporary dressing to acute open fractures. CONCLUSION The conclusions drawn from our study, Guistilo Anderson type 3 B open fractures were most commonly caused by road traffic accidents. Males were more prone than females. The most common bone involved, Vacuum assisted closure therapy appears to be a viable adjunct for the treatment of open musculoskeletal injuries, Application of sub atmospheric pressure after the initial debridement to the wounds results in an increase in local functional blood perfusion, an accelerated rate of granulation tissue formation, and decrease in tissue bacterial levels. The granulation tissue formed was healthy and uniform.
Treatment principles in the management of open fractures
Indian Journal of Orthopaedics, 2008
The management of open fractures continues to provide challenges for the orthopedic surgeon. Despite the improvements in technology and surgical techniques, rates of infection and nonunion are still troublesome. Principles important in the treatment of open fractures are reviewed in this article. Early antibiotic administration is of paramount importance in these cases, and when coupled with early and meticulous irrigation and debridement, the rates of infection can be dramatically decreased. Initial surgical intervention should be conducted as soon as possible, but the classic 6 h rule does not seem to be supported in the literature. All open fractures should be addressed for the risk of contamination from Clostridium tetani. When possible, early closure of open fracture wounds, either by primary means or by ß aps, can also decrease the rate of infection, especially from nosocomial organisms. Early skeletal stabilization is necessary, which can be accomplished easily with temporary external Þ xation. Adhering to these principles can help surgeons provide optimal care to their patients and assist them in an early return to function.
Antibiotic Prophylaxis in the Management of Open Fractures
JBJS Reviews, 2019
Background: Evidence with regard to antibiotic prophylaxis for patients with open fractures of the extremities is limited. We therefore conducted a systematic survey addressing current practice and recommendations. Methods: We included publications from January 2007 to June 2017. We searched Embase, MEDLINE, CINAHL, the Cochrane Central Registry of Controlled Trials (CENTRAL), and the Cochrane Database of Systematic Reviews for clinical studies and surveys of surgeons; WorldCat for textbooks; and web sites for guidelines and institutional protocols. Results: We identified 223 eligible publications that reported 100 clinical practice patterns and 276 recommendations with regard to systemic antibiotic administration, and 3 recommendations regarding local antibiotic administration alone. Most publications of clinical practice patterns used regimens with both gram-positive and gram-negative coverage and continued the administration for 2 to 3 days. Most publications recommended prophylactic systemic antibiotics. Most recommendations suggested gram-positive coverage for less severe injuries and administration duration of 3 days or less. For more severe injuries, most recommendations suggested broad antimicrobial coverage continued for 2 to 3 days. Most publications reported intravenous administration of antibiotics immediately. Conclusions: Current practice and recommendations strongly support early systemic antibiotic prophylaxis for patients with open fractures of the extremities. Differences in antibiotic regimens, doses, and durations of administration remain in both practice and recommendations. Consensus with regard to optimal practice will likely require welldesigned randomized controlled trials. Clinical Relevance: The current survey of literature systematically provides surgeons' practice and the available expert recommendations from 2007 to 2017 on the use of prophylactic antibiotics in the management of open fractures of extremities. O pen fractures involve the protrusion of bone through skin resulting in skin and soft-tissue compromise. This may be the result of an inside-out type injury, as can be seen in high-energy or other crush-type injuries 1-4. In open fractures, there is a higher risk of infection that may not only contribute to woundhealing problems, but may also play an important role in the subsequent development of nonunion and continued osseous Disclosure: There was no source of external funding for this study. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/ JBJSREV/A428).
Attempting primary closure for all open fractures: the effectiveness of an institutional protocol.
Canadian Journal of Surgery, 2014
BACKGROUND: Immediate primary closure of open fractures has been historically believed to increase the risk of wound infection and fracture nonunion. Recent literature has challenged this belief, but uncertainty remains as to whether primary closure can be used as routine practice. This study evaluates the impact of an institutional protocol mandating primary closure for all open fractures. METHODS: We retrospectively reviewed all open fractures treated in a single level 1 trauma centre in a 5-year period. Prior to the study, a protocol was adopted standardizing management of open fractures and advocating primary closure of all wounds as a necessary goal of operative treatment. Patient and fracture characteristics, type of wound closure and development of infectious and bone healing complications were evaluated from time of injury to completion of outpatient follow-up. RESULTS: A total of 297 open fractures were treated, 255 (85.8%) of them with immediate primary closure. Type III open injuries accounted for 24% of all injuries. Wounds that were immediately closed had a superficial infection rate of 11% and a deep infection rate of 4.7%. Both proportions are equivalent to or lower than historical controls for delayed closure. Fracture classification, velocity of trauma and time to wound closure did not correlate significantly with infection, delayed union or nonunion. CONCLUSION: Attempting primary closure for all open fractures is a safe and efficient practice that does not increase the postoperative risk of infection and delayed union or nonunion.
World journal of emergency surgery : WJES, 2016
Traumatic wounds are one of the most common problems leading people to the Emergency Department (ED), accounting for approximately 5,4 % of all the visits, and up to 24 % of all the medical lawsuits. In order to provide a standardized method for wound management in the ED, we have organized a workshop, involving several Italian and European experts. Later, all the discussed statements have been submitted for external validation to a multidisciplinary expert team, based on the so called Delphi method. Eight main statements have been established, each of them comprising different issues, covering the fields of wound classification, infectious risk stratification, tetanus and rabies prophylaxis, wound cleansing, pain management, and suture. Here we present the results of this work, shared by the Academy of Emergency Medicine and Care (AcEMC), and the World Society of Emergency Surgery (WSES).