Evaluation of a new system of wound irrigation and debridement (original) (raw)

, and whose medical notes were available were included in the audit. Results: Sixty-eight patients were available for analysis. They included 44 (65%) male and 24 (35%) female with mean age of 36 (2-101). There were varying grades of injury: 24% Gustillo and Anderson Grade I, 39% Grade II, 16% Grade IIIa, 18% IIIb and 3% IIIc. Only 3% of cases had documented evidence of appropriate wound care in A&E. Ninety-three percent of patients received IV antibiotics given at a mean time from injury of 2 h 37 min. Of the 44% of cases referred to plastics, only 13% (4/30) of referrals were made before the initial procedure. The mean time from injury to initial operative procedure was 9 h 34 min (median 5 h 22 min). Only 23% of cases were carried out with a consultant present. Ten of 62 cases (six lost to follow-up) were complicated by infection, 2 (3%) of which were deep. Two cases of compartment syndrome occurred requiring fasciotomy. All fractures united with a mean time to union of 39 weeks. The most striking problem was the poor quality of note keeping and hence difficulty in obtaining accurate data. Conclusions: The results show that in a number of crucial areas the guidelines are not adhered to. However, the complication rate in terms of nonunion and deep infection is respectable compared to current literature. One cannot read too much into this due to the problems with data collection. The department should examine its current protocol and perform a prospective audit thereby obtaining an accurate picture of its results. In the meantime emergent debridement of soft tissues, fracture stabilisation and early administration of intravenous antibiotics should be supported.