Variation in practice preferences in management of open injuries of extremities—an international survey by SICOT research academy

Kamal, Arun; Kanakeshwar, Raja Bhaskara; Shyam, Ashok; Jayaramaraju, Dheenadhayalan; Devendra, Agraharam; Perumal, Ramesh; Rajasekaran, Raja Bhaskara

doi:10.1007/s00264-016-3311-3

Cited by 6 publications

(3 citation statements)

References 57 publications

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“…39 Irrigation practices are highly variable and not always evidence-based. [40][41][42] This is the first review of wound irrigation that systematically summarizes the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and distills the evidence into a practical format. This work not only represents a valuable addition to the literature as a "one-stop-shop" for information, but also helps mitigate against methods that may do harm.…”

Section: Discussionmentioning

confidence: 99%

Evidence-Based Wound Irrigation: Separating Fact from Fiction

Saeg

Schoenbrunner

Janis

2021

Plastic &Amp; Reconstructive Surgery

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The relationship between wound irrigation and healing has been recognized for centuries. However, there is little evidence and no official recommendations from any health care organization regarding best wound irrigation practices. This is the first review of wound irrigation that systematically summarizes the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and distills the evidence into a practical format. In this comprehensive review, the authors outline the irrigation fluids and delivery methods used in the identified studies, analyze reported treatment outcomes, summarize irrigation effectiveness, and propose evidence-based guidelines to improve wound healing outcomes and enhance the consistency of wound irrigation. Thirty-one high-quality studies with a combined total of 61,808 patients were included. Based on the current evidence provided by this review, the authors propose the following guidelines: (1) acute soft-tissue wounds should receive continuous gravity flow irrigation with polyhexanide; (2) complex wounds should receive continuous negative-pressure wound therapy with instillation with polyhexanide; (3) infected wounds should receive continuous negative-pressure wound therapy with instillation with silver nitrate, polyhexanide, acetic acid, or povidone-iodine; (4) breast implant wounds should receive gravity lavage with povidone-iodine or antibiotics; and (5) surgical-site infection rates can be reduced with intraoperative povidone-iodine irrigation. (Plast.

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Section: Discussionmentioning

confidence: 99%

Evidence-Based Wound Irrigation: Separating Fact from Fiction

Saeg

Schoenbrunner

Janis

2021

Plastic &Amp; Reconstructive Surgery

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“…Although high-quality studies have addressed questions related to the outcome of TSFs [28,29], essential knowledge gapsspecifically within the field of FRIremain. Multiple surveys indeed demonstrate a wide variability in clinical practice related to the prevention of musculoskeletal complications, especially in open fractures [27,30,31]. Puetzler et al stated that global heterogeneity exists among orthopedic trauma surgeons concerning measures taken to prevent FRI [27].…”

Section: Discussionmentioning

confidence: 99%

Fracture-related outcome study for operatively treated tibia shaft fractures (F.R.O.S.T.): registry rationale and design

Metsemakers

Kortram

Ferreira

et al. 2021

BMC Musculoskelet Disord

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Background Tibial shaft fractures (TSFs) are among the most common long bone injuries often resulting from high-energy trauma. To date, musculoskeletal complications such as fracture-related infection (FRI) and compromised fracture healing following fracture fixation of these injuries are still prevalent. The relatively high complication rates prove that, despite advances in modern fracture care, the management of TSFs remains a challenge even in the hands of experienced surgeons. Therefore, the Fracture-Related Outcome Study for operatively treated Tibia shaft fractures (F.R.O.S.T.) aims at creating a registry that enables data mining to gather detailed information to support future clinical decision-making regarding the management of TSF’s. Methods This prospective, international, multicenter, observational registry for TSFs was recently developed. Recruitment started in 2019 and is planned to take 36 months, seeking to enroll a minimum of 1000 patients. The study protocol does not influence the clinical decision-making procedure, implant choice, or surgical/imaging techniques; these are being performed as per local hospital standard of care. Data collected in this registry include injury specifics, treatment details, clinical outcomes (e.g., FRI), patient-reported outcomes, and procedure- or implant-related adverse events. The minimum follow up is 12 months. Discussion Although over the past decades, multiple high-quality studies have addressed individual research questions related to the outcome of TSFs, knowledge gaps remain. The scarcity of data calls for an international high-quality, population-based registry. Creating such a database could optimize strategies intended to prevent severe musculoskeletal complications. The main purpose of the F.R.O.S.T registry is to evaluate the association between different treatment strategies and patient outcomes. It will address not only operative techniques and implant materials but also perioperative preventive measures. For the first time, data concerning systemic perioperative antibiotic prophylaxis, the influence of local antimicrobials, and timing of soft-tissue coverage will be collected at an international level and correlated with standardized outcome measures in a large prospective, multicenter, observational registry for global accessibility. Trial registration ClinicalTrials.gov: NCT03598530.

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“…Since its introduction in 1976, multiple modifications have been suggested, and the most recent proposed by the original authors can still be used to optimize communication and initial management of these patients [6]. A recent survey conducted by the Italian Society of Orthopedics and Traumatology (SICOT) research academy highlighted that about 94.7% of orthopedic surgeons around the world use the Gustilo-Anderson scoring system for assessments of open injury [7,8].…”

Section: Introductionmentioning

confidence: 99%

High-Grade Limbs Open Fractures: Time to Find Milestones in the Emergency Setting

Altomare

Granieri

Cioffi

et al. 2021

Life

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(1) Background: The Gustilo–Anderson (G/A) grading system is a universally accepted tool used to classify high-grade limb open fractures. The purpose of this study is to find early independent predictors of amputation in emergency settings. (2) Methods: A retrospective analysis involving patients treated at our center between 2010 and 2016 was conducted. Patients with at least one G/A grade III fracture or post-traumatic amputation were included. Three groups were identified: G/A IIIA (A group), G/A IIIB-C (BC group), and Amputation group (AMP group). Each group was further divided into two subgroups considering timing of coverage (early vs. delayed). Univariate and multivariate logistic regression models were developed to identify independent predictors of the limb’s outcome. (3) Results: One-hundred-six patients with G/A III A-B-C fractures or amputation of the affected limb were selected from the Niguarda Hospital Trauma Registry. The patients were divided into the A group (26), BC group (66), and AMP group (14). The rate of infectious complications following early or delayed coverage was evaluated: A group, 9.1% vs. 66.7% (p > 0.05); BC group, 32% vs. 63.6% (p = 0.03); and AMP group, 22% vs. 18.5% (p > 0.05). After further recategorization, the BC subgroups were analyzed: multivariate logistic regression model identified systolic blood pressure (SBP) <90 mmHg (p = 0.03) and Mangled Extremity Severity Score MESS ≥ 7 (p = 0.001) were determined to be independent predictors of limb amputation. (4) Conclusion: MESS and SBP serve as predictors of amputation. Based on the results, we propose a new management algorithm for mangled extremities. Early coverage is related to lower rates of infectious complications. Referral to high-volume centers with specific expertise is mandatory to guarantee the best results.

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Variation in practice preferences in management of open injuries of extremities—an international survey by SICOT research academy

Abstract: Our study documented wide variations in practice preferences across the world and showed that information and awareness about current guidelines and practices will help many to update themselves in terms of basic questions about open fracture care.

Cited by 6 publications

References 57 publications

Evidence-Based Wound Irrigation: Separating Fact from Fiction

Evidence-Based Wound Irrigation: Separating Fact from Fiction

Fracture-related outcome study for operatively treated tibia shaft fractures (F.R.O.S.T.): registry rationale and design

High-Grade Limbs Open Fractures: Time to Find Milestones in the Emergency Setting

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