Vacuum-Assisted Closure (V.A.C.�) for Temporary Coverage of Soft-Tissue Injury in Type III Open Fracture of Lower Extremities

Background: The soft tissues injury in periarticular fractures of the lower extremities determines the proper time to perform bone fixation. Objetive: The aim of this study was to determine the intra and interobserver agreement in the Tscherne classification. Methods: This is a descriptive, prospective study for patients admitted to the Pablo Tobón Uribe Hospital (PTUH) with tibial plateau or tibial pilon fractures. We performed a standardize evaluation using video photography at the time of admission and 24, 48, and 72 h after admission. Fifteen five reviewers who had various levels of training produced a total of 1,200 observations. The intra- and interobserver agreement was assessed using a weighted kappa for multiple raters and more than two categories. Results: Twenty patients were admitted with tibial plateau and tibial pilon fractures. The intraobserver agreement for all 15 raters was kappa 0.81 (95% CI 0.79-0.83), and the interobserver agreement for all 15 raters was kappa 0.65 (95% CI 0.55-0.73). The interobserver agreement at 24 h was kappa 0.67 (95% CI 0.46-0.86). Conclusions:Classifying the severity of soft tissue injury is critical in planning the surgical management of fractures of the lower extremities. Based on our results, we can reasonably argue that the Tscherne classification produced an adequate level of agreement and could be used to standardize and to guide the treatment, and to conduct research studies. Level of Evidence: Level IV, Case Series

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Soft-tissue injury management and flap reconstruction for mangled lower extremities

Injury ◽

10.1016/j.injury.2008.08.034 ◽

2008 ◽

Vol 39 ◽

pp. 75-95 ◽

Cited By ~ 18

Author(s):

Yuan-Kun Tu ◽

Cheng-Yo Yen ◽

Ching-Hou Ma ◽

Shang-Won Yu ◽

Ying-Chao Chou ◽

...

Keyword(s):

Soft Tissue ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Lower Extremities ◽

Flap Reconstruction ◽

Injury Management

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Cefazolin sodium pentahydrate combined with vacuum sealing drainage in the treatment of open fracture complicated with soft tissue injury

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.66.4.430 ◽

2020 ◽

Vol 66 (4) ◽

pp. 430-436

Author(s):

Wenjie Lou ◽

Kai Zou ◽

Zhongbin Yu ◽

Song Qin ◽

Kai Wang ◽

...

Keyword(s):

Soft Tissue ◽

Open Fracture ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Serum Levels ◽

Control Group ◽

Observation Group ◽

Tnf Α ◽

Cefazolin Sodium ◽

Vacuum Sealing Drainage

SUMMARY OBJECTIVE To investigate the clinical efficacy of cefazolin sodium pentahydrate combined with vacuum sealing drainage (VSD) in the treatment of open fracture complicated with soft tissue injury. METHODS Sixty-three patients with open fracture complicated with soft tissue injury were divided into observation (n = 33) and control (n = 30) groups. After surgical reduction, fixation, and repair of the fractures, the control group was treated with VSD for 10 days, and the observation group was treated with cefazolin sodium pentahydrate based on VSD for 10 days. The infection control time was recorded. After treatment, the pain of patients was evaluated. Before and after treatment, the serum levels of C-reactive protein (CRP), interleukin (IL)-6, IL-8, tumor necrosis factor α (TNF-α), cortisol, epinephrine, norepinephrine, and glucose were detected. After 6 months of treatment, the total effective rate of the treatment was evaluated. RESULTS The infection control time and Visual Analogue Scale score after treatment in the observation group were significantly lower than in the control group, respectively (P < 0.05). After the treatment, the serum levels of CRP, IL-6, IL-8, TNF-α, cortisol, epinephrine, norepinephrine, and glucose in each group were significantly lower than before the treatment (P < 0.05), and each index in observation was significantly lower than in the control group (P < 0.05). CONCLUSIONS In the treatment of open fractures complicated with soft tissue injury, cefazolin sodium pentahydrate combined with VSD can effectively reduce inflammation and stress, thus improving the treatment efficacy.

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Evaluation of Vacuum Assisted Closure Therapy for Soft Tissue Injury in Open Musculoskeletal Trauma

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2016/17449.7598 ◽

2016 ◽

Cited By ~ 1

Author(s):

Manish Raj

Keyword(s):

Soft Tissue ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Vacuum Assisted Closure ◽

Musculoskeletal Trauma ◽

Vacuum Assisted Closure Therapy

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Combat-Related Extremity Wounds: Injury Factors Predicting Early Onset Infections

Military Medicine ◽

10.1093/milmed/usy336 ◽

2019 ◽

Vol 184 (Supplement_1) ◽

pp. 83-91

Author(s):

Laveta Stewart ◽

Faraz Shaikh ◽

William Bradley ◽

Dan Lu ◽

Dana M Blyth ◽

...

Keyword(s):

Soft Tissue ◽

Open Fracture ◽

Tissue Injury ◽

Hazard Analysis ◽

Soft Tissue Injury ◽

Open Fractures ◽

Severe Injury ◽

Wound Classification ◽

Military Patients ◽

Improvised Explosive

Abstract We examined risk factors for combat-related extremity wound infections (CEWI) among U.S. military patients injured in Iraq and Afghanistan (2009–2012). Patients with ≥1 combat-related, open extremity wound admitted to a participating U.S. hospital (≤7 days postinjury) were retrospectively assessed. The population was classified based upon most severe injury (amputation, open fracture without amputation, or open soft-tissue injury defined as non-fracture/non-amputation wounds). Among 1271 eligible patients, 395 (31%) patients had ≥1 amputation, 457 (36%) had open fractures, and 419 (33%) had open soft-tissue wounds as their most severe injury, respectively. Among patients with traumatic amputations, 100 (47%) developed a CEWI compared to 66 (14%) and 12 (3%) patients with open fractures and open soft-tissue wounds, respectively. In a Cox proportional hazard analysis restricted to CEWIs ≤30 days postinjury among the traumatic amputation and open fracture groups, sustaining an amputation (hazard ratio: 1.79; 95% confidence interval: 1.25–2.56), blood transfusion ≤24 hours postinjury, improvised explosive device blast, first documented shock index ≥0.80, and >4 injury sites were independently associated with CEWI risk. The presence of a non-extremity infection at least 4 days prior to a CEWI diagnosis was associated with lower CEWI risk, suggesting impact of recent exposure to directed antimicrobial therapy. Further assessment of early clinical management will help to elucidate risk factor contribution. The wound classification system provides a comprehensive approach in assessment of injury and clinical factors for the risk and outcomes of an extremity wound infection.

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Flaps in the management of open tibial fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191792 ◽

2019 ◽

Vol 5 (3) ◽

pp. 504

Author(s):

T. Karikalan

Keyword(s):

Soft Tissue ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Tibial Fractures ◽

Tissue Loss ◽

Wound Debridement ◽

Open Tibial Fractures ◽

Type Iii ◽

Soft Tissue Loss ◽

Flap Cover

Background: The prognosis in open fractures is primarily determined by the amount of soft tissue loss and the level of contamination. Severe open tibial fractures usually require combined orthoplastic approach in the management. Our aim is to study the effectiveness of soft tissue flaps in the management of type III B open tibial fractures.Methods: The study material consists of 20 cases of grade III B open tibial fractures admitted in our institution. Under anaesthesia, wound debridement was done and fracture stabilised with external fixator or IM nail depending upon the wound status. Patient underwent flap cover once the wound was fit. Periodic follow up was done.Results: Nonunion occurred in one patient (5%). Chronic osteomyelitis developed in two patients (10%). Deep infection occurred in three cases (15%). There was no secondary amputation in our series. The average union time of fracture was 30.1 weeks. Lower third fractures and those patients with extensive soft tissue injury, delayed flap cover and flap failure had longer union time.Conclusions: Fasciocutaneous flap has definitive role in the management of type III B open tibial fractures with soft tissue loss.

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