The principles and practice of open fracture care, 2018

Abstract

The principles of open fracture management are to manage the overall injury and specifically prevent primary contamination becoming frank infection. The surgical management of these complex injuries includes debridement & lavage of the open wound with combined bony and soft tissue reconstruction. Good results depend on early high quality definitive surgery usually with early stable internal fixation and associated soft tissue repair. While all elements of the surgical principles are very important and depend on each other for overall success the most critical element appears to be achieving very early healthy soft tissue cover. As the injuries become more complex this involves progressively more complex soft tissue reconstruction and may even requiring urgent free tissue transfer requiring close co-operative care between orthopaedic and plastic surgeons. Data suggests that the best results are obtained when the whole surgical reconstruction is completed within 48–72 h.

Skeletal Muscle Tissue Engineering: Biomaterials-Based Strategies for the Treatment of Volumetric Muscle Loss

“…While FFMT has been moderately successful in salvaging limbs and restoring some muscle function, muscle flaps remain unable to completely restore muscle function [22][23][24][25]. This procedure is also complicated and time consuming to perform and requires the expertise of skilled orthopedic and microvascular surgeons, which may limit its widespread use [19,26]. Additionally, a high instance of muscle flap procedures result in complications such as infection, graft failure, and donor site morbidity due to tissue necrosis [21,22,27,28].…”

Single-stage "Fix and Flap" gives Good Outcomes in Grade 3B/C Open Tibial Fractures: A Prospective Study

“…However, due to financial as well as logistic issues, including long operation wait-lists endemic in underdeveloped countries, this single-stage approach would be better suited for overcrowded tertiary care centres in developing countries. Recent studies [45][46][47] also emphasised the importance of single-stage definitive ortho-plastic reconstruction in severe open tibial fractures leading to good outcomes and significantly decreased infection rates.…”

Management of the High Energy Traumatism of the Limbs

“…When proceeding to the operation room with the patient, some well selected patients may benefit from the damage control technique, prioritising the life-threatening injury treatment to limb salvage procedures. An experienced surgeon is the best person to do initial debridement because poorly planned incisions can affect the next reconstructive therapeutic options and eventually the quality of patients' life [17].…”

“…Several methods can be found while meticulously searching the literature. If the cardiovascular status of the patient is unstable, the lesion is considered susceptible to infection or serious injured (GA IIIA-IIIC), it is preferred to use an external fixator [17]. The position of the external fixator should occupy less space so that further interventions can be performed to the wound place, for example second debridement, skin flaps etc.…”