Wound Irrigation in Orthopedic Open Fractures: A Review

Gardezi, Mursal; Roque, Daniel; Barber, Douglas B.; Spake, Carole S.L.; Glasser, Jillian; Berns, Ellis; Antoci, Valentin; Born, Christopher T.; Garcia, Dioscaris

doi:10.1089/sur.2020.075

Cited by 12 publications

(9 citation statements)

References 68 publications

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“…Se considera que el desbridamiento acompañado con irrigación de solución salina a baja presión reduce la carga bacteriana y elimina los contaminantes sin alterar significativamente los procesos normales de curación (8).…”

Section: Discussionunclassified

Manejo Integral de Fractura Expuesta de Tibia Proximal. Reporte de Caso

Tapia Alburquerque,

Mahecha Guzmán,

Trujillo Altamirano

et al. 2024

Ciencia Latina

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Las fracturas abiertas de tibia proximal son lesiones complejas de pronóstico variable donde existe pérdida de la continuidad ósea y comunicación con el ambiente externo. La proximidad de la tibia a la piel la hace propensa a sufrir daños extensos en los tejidos blandos y complicaciones perjudiciales posteriores por lo que deben ser manejadas por traumatólogos y cirujanos plásticos para abordar las lesiones tanto en el hueso como en los tejidos blandos. Los objetivos principales del tratamiento son lograr la estabilidad y la restauración de las superficies articulares esto es posible gracias al avance de las herramientas terapéuticas como el uso de oxígeno hiperbárico. Se reporta el caso de un paciente de 56 años, masculino, es traído en ambulancia a emergencias del Hospital General HOSNAG, tras sufrir accidente de tránsito con su vehículo, dando como resultado una fractura expuesta de tercio proximal de tibia con una considerable tumefacción y contusión de partes blandas. Es hospitalizado, se le realiza limpieza quirúrgica, colocación de tutores, corticotomía, colocación del sistema VAC, oxigenoterapia hiperbárica, colgajo de músculo gemelo medial e injerto de piel.

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Section: Discussionunclassified

Manejo Integral de Fractura Expuesta de Tibia Proximal. Reporte de Caso

Tapia Alburquerque,

Mahecha Guzmán,

Trujillo Altamirano

et al. 2024

Ciencia Latina

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“…5 Chlorhexidine exerts a bactericidal effect on gram positive organisms at low concentrations, whereas higher concentrations are necessary for effectiveness against gram negative and fungal organisms. 30,32 Its largest benefits are persistence, having been shown to be effective for up to 6 hours on the skin, and being not significantly affected by blood or organic material. 31 At higher concentrations, however, chlorhexidine has been shown to cause host cell toxicity and, therefore, is not recommended in the setting of open wounds.…”

Section: Surgical Preparation and Sterile Techniquementioning

confidence: 99%

“…Moreover, the CDC recommends utilizing an alcohol-based preparation unless contraindicated 5. Chlorhexidine exerts a bactericidal effect on gram positive organisms at low concentrations, whereas higher concentrations are necessary for effectiveness against gram negative and fungal organisms 30,32. Its largest benefits are persistence, having been shown to be effective for up to 6 hours on the skin, and being not significantly affected by blood or organic material 31.…”

Section: Infection Risk Factors and Preventative Strategiesmentioning

confidence: 99%

Postoperative Infection: Prevention, Diagnosis, and Treatment Guidelines for the Sports Surgeon

Pullen

Money

Ray

et al. 2022

Sports Medicine and Arthroscopy Review

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Postoperative infection remains a potentially devastating complication facing the sports medicine surgeon. Infection prevention begins with a thorough history and physical examination to identify patient specific risk factors and aid in risk stratification. Perioperative steroid injections should be used cautiously, with increased time prior to or following surgery being associated with lower infection risk. Sterile preparation with an alcohol containing solution is typically preferred, though there is limited evidence to identify which product is superior. Diagnosis can be challenging with a high index of suspicion needed to identify and appropriately manage patients. Treatment involves prompt irrigation and debridement with deep cultures. Antibiotic coverage should begin with empiric broad treatment and be tailored based on culture results. Early consultation with an infectious disease specialist is recommended to ensure appropriate antibiotic coverage and duration of treatment.

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“…50 This practice has been extensively questioned by emerging evidence on the type, volume and flow of irrigation. 48,82 Several studies have demonstrated that high-pressure pulsatile lavage is superior at removing bacteria and debris compared to low-pressure. 48 On the contrary, numerous animal and experimental studies have suggested that high-pressure pulsatile lavage can have deleterious effects by causing tissue damage in the wound.…”

Section: Irrigationmentioning

confidence: 99%

Open tibial fractures: An overview

Nicolaides

Pafitanis

Vris

2021

Journal of Clinical Orthopaedics and Trauma

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Open tibial fractures are complex injuries with multifactorial outcomes and variable prognosis. The close proximity of the tibia to the skin makes it prone to extensive soft tissue damage and subsequent detrimental complications, such as infection and non-union. Thus, they were historically associated with high rates of amputation, sepsis, or even death. The advancement of surgical instruments and techniques, along the emergence of evidence-based guidance, have resulted in a significant reduction in complications. Peculiarly though, modern management strategies have a strong foundation in practices described in the ancient times. Nevertheless, post-operative complications are still a challenge in the management of open tibial fractures. Efforts are actively being made to refine the surgical approaches used, while noteworthy is the emergence of the Orthoplastic approach. The aim of this review is to summarise and discuss the historical perspective of the management of open tibial fractures, their epidemiology and classification, up-to-date principles of surgical management and outcomes following injury.

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Wound Irrigation in Orthopedic Open Fractures: A Review

Cited by 12 publications

References 68 publications

Manejo Integral de Fractura Expuesta de Tibia Proximal. Reporte de Caso

Manejo Integral de Fractura Expuesta de Tibia Proximal. Reporte de Caso

Postoperative Infection: Prevention, Diagnosis, and Treatment Guidelines for the Sports Surgeon

Open tibial fractures: An overview

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