scholarly journals Concepts in wound irrigation of open fractures: ‘Where we came from, and where are we now?

2021 ◽  
pp. 101638
Author(s):  
Ravi Gupta ◽  
Atul Rai Sharma ◽  
Akash Singhal ◽  
Sumukh Shail ◽  
Gladson David Masih
Keyword(s):  
Open Fractures ◽  
Wound Irrigation

Emergency management of open fractures

2021 ◽  
Vol 26 (10) ◽  
pp. 1-12
Author(s):  
Michelle Cesarano ◽  
Brea Sandness ◽  
Karen L Perry
Keyword(s):  
Emergency Management ◽  
Open Fractures ◽  
Complication Rates ◽  
Wound Irrigation ◽  
Local Antibiotics ◽  
Sterile Saline ◽  
Wound Debridement ◽  
Primary Wound Closure ◽  
Systemic Antibiotic Therapy ◽  
Increased Risk

Open fractures are associated with an increased risk of complications, such as infection or nonunion, and present a therapeutic challenge. The incidence of such complications is directly influenced by how they are treated in the first several hours after presentation. As such, the focus of this article is to adopt an evidence-based approach to guide open fracture emergency management and minimise complication rates. Upon initial presentation, the potential for concomitant life-threatening injuries should be investigated and the patient stabilised as necessary. Critical components of emergency management that have been shown to impact on complication rates include initial classification of the fracture, the prompt instigation of broad-spectrum systemic antibiotic therapy, the use of local antibiotics in select cases and copious wound irrigation using sterile saline. As long as antibiosis is attended to appropriately, small delays in wound debridement do not translate to increased complication rates and waiting for an experienced surgical team is recommended. In cases with no severe tissue damage or contamination, primary wound closure results in lower infection rates and can be recommended. In cases where primary closure is not an option, the wound should be sealed to prevent contamination with nosocomial pathogens.

Wound Irrigation in Orthopedic Open Fractures: A Review

2020 ◽  
Author(s):  
Mursal Gardezi ◽  
Daniel Roque ◽  
Douglas Barber ◽  
Carole S.L. Spake ◽  
Jillian Glasser ◽  
...  
Keyword(s):  
Open Fractures ◽  
Wound Irrigation

Wound Irrigation for Open Fractures

JBJS Reviews ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. e0061
Author(s):  
Nathanael Heckmann ◽  
Trevor Simcox ◽  
Daniel Kelley ◽  
Geoffrey S. Marecek
Keyword(s):  
Open Fractures ◽  
Wound Irrigation

Limb and Flap Salvage in Gustilo IIIC Injuries Treated by Vascular Repair and Emergency Free Flap Transfer

2017 ◽  
Vol 33 (S 01) ◽  
pp. S03-S07 ◽  
Author(s):  
Giovanni Papa ◽  
Vittorio Ramella ◽  
Federico Novati ◽  
Uros Ahcan ◽  
Chiara Stocco ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Free Flap ◽  
Open Fractures ◽  
High Rate ◽  
Long Term Results ◽  
Vascular Repair ◽  
Wound Irrigation ◽  
Flap Transfer ◽  
Free Flap Transfer ◽  
Emergency Free Flap

Background Gustilo classification system defines IIIC fractures as open fractures associated with an arterial injury that requires repair. The aim of our study was to analyze the early outcome in terms of limb and flap salvage, early amputation, and early complication rate in patients with Gustilo IIIC open fractures treated in an emergency setup. Methods We retrospectively reviewed 20 patients with Gustilo IIIC injuries treated by the “fix and flap” principle during the first surgical procedure in the first 24 hours after injury (emergency free flap transfer). All patients underwent surgery with radical debridement, wound irrigation, skeletal stabilization, vascular repair, and immediate free flap coverage. Results In this study, 18 patients were men (90%) and 2 were women (10%). In all patients, a vascular repair was performed and in 17 cases (85%), the lower limb/foot was avascular and limb salvage was performed. Three patients had one vessels injured (15%) and 17 had two or three vessels injured (85%). In 9 out of 20 (45%), a revision surgery was needed for arterial (10%, 2 patients), arterial–venous (15%, 3 patients), and venous thrombosis (20%, 4 patients), while 4 patients required an early amputation (20%) and 1, a late one (5%). In three patients (15%), a flap loss occurred. Superficial infection occurred in seven cases (35%) and deep infection (osteomyelitis) in one (5%). Conclusion A single-stage procedure performed in an emergency operating room could lead to an effective outcome with a high rate of limb salvage and satisfying long-term results.

The Safety and Antimicrobial Properties of Stabilized Hypochlorous Acid in Acetic Acid Buffer for the Treatment of Acute Wounds—a Human Pilot Study and In Vitro Data

2021 ◽  
pp. 153473462110156
Author(s):  
Ewa A. Burian ◽  
Lubna Sabah ◽  
Klaus Kirketerp-Møller ◽  
Elin Ibstedt ◽  
Magnus M. Fazli ◽  
...  
Keyword(s):  
Pilot Study ◽  
Hypochlorous Acid ◽  
Treatment Time ◽  
Donor Site ◽  
Antimicrobial Properties ◽  
Prolonged Treatment ◽  
Wound Irrigation ◽  
The Mean ◽  
And Performance

Acute wounds may require cleansing to reduce the risk of infection. Stabilized hypochlorous acid in acetic buffer (HOCl + buffer) is a novel wound irrigation solution with antimicrobial properties. We performed a first-in-man, prospective, open-label pilot study to document preliminary safety and performance in the treatment of acute wounds. The study enrolled 12 subjects scheduled for a split-skin graft transplantation, where the donor site was used as a model of an acute wound. The treatment time was 75 s, given on 6 occasions. A total of 7 adverse events were regarded as related to the treatment; all registered as pain during the procedure for 2 subjects. One subject had a wound infection at the donor site. The mean colony-forming unit (CFU) decreased by 41% after the treatment, and the mean epithelialization was 96% on both days 14 (standard deviation [SD] 8%) and 21 (SD 10%). The study provides preliminary support for the safety, well-tolerance, and efficacy of HOCl + buffer for acute wounds. The pain was frequent although resolved quickly. Excellent wound healing and satisfying antimicrobial properties were observed. A subsequent in vitro biofilm study also indicated good antimicrobial activity against Pseudomonas aeruginosa with a 96% mean reduction of CFU, when used for a treatment duration of 15 min ( P < .0001), and a 50% decrease for Staphylococcus aureus ( P = .1010). Future larger studies are needed to evaluate the safety and performance of HOCl + buffer in acute wounds, including the promising antimicrobial effect by prolonged treatment on bacterial biofilms.

scholarly journals 1005 Antibiotic-Impregnated Calcium Sulfate Beads Are Not Effective in the Primary Prevention of Infection in Open Femur and Tibia Fractures

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Fung ◽  
A Ward ◽  
K Patel ◽  
M Krkovic
Keyword(s):  
Primary Prevention ◽  
Infection Rate ◽  
Calcium Sulfate ◽  
Acute Infection ◽  
Open Fractures ◽  
Prevention Of Infection ◽  
Significant Difference ◽  
Tibia Fractures ◽  
Systemic Antibiotics

Abstract Introduction Infection is a major complication of open fractures. Antibiotic-impregnated calcium sulfate (AICS) beads are widely used as an adjuvant to systemic antibiotics. Whilst their efficacy in the secondary prevention of infection is established, we present the first retrospective study evaluating AICS beads in the primary prevention of infection in open fractures. Method 214 open femur and tibia fractures in 207 patients were reviewed over a seven-year period. 148 fractures received only systemic antibiotic prophylaxis. 66 fractures also received AICS beads. The occurrence of acute infection (wound infection and acute osteomyelitis) was recorded, as well as that of long-term complications (chronic osteomyelitis, non-union and death). Results Fractures that received AICS with systemic antibiotics had an overall acute infection rate of 42% (28/66), compared to 43% (63/148) in fractures that received only systemic antibiotics (p &gt; 0.05). There was no significant difference in infection rate even when fractures were stratified by Gustilo-Anderson grade. There was also no significant difference in the rate of long-term complications. Conclusions Our results indicate that the adjuvant use of AICS beads is not effective for the primary prevention of acute infection or long-term complications in open leg fractures. Further research is needed to elucidate the factors influencing the outcomes of AICS use.

scholarly journals 405 Radiological Analysis of Gentamicin Eluting Synthetic Bone Graft Substitute Used in The Management of Gustilo IIIB Open Fractures

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Aljawadi ◽  
I Madhi ◽  
T Naylor ◽  
M Elmajee ◽  
A Islam ◽  
...  
Keyword(s):  
Bone Graft ◽  
Cortical Thickness ◽  
Bone Graft Substitute ◽  
Fracture Site ◽  
Open Fractures ◽  
X Rays ◽  
Radiographic Images ◽  
Synthetic Bone ◽  
Synthetic Bone Graft

Abstract Background Management of traumatic bone void associated with Gustilo IIIB open fractures is challenging. Gentamicin eluting synthetic bone graft substitute (Cerament-G) had been recently utilised for the management of patients with these injuries. This study aims to assess radiological signs of Cerament-G remodelling. Method Retrospective data analysis of all patients admitted to our unit with IIIB open fractures who had Cerament-G applied as avoid filler. Postoperative radiographic images of the fracture site at 6-weeks, 3-months, 6-months and at the last follow-up were reviewed. The radiological signs of Cerament-G integration, percent of void healing, and bone cortical thickness at the final follow-up were assessed. Results 34 patients met our inclusion criteria, mean age: 42 years. Mean follow-up time was 20 months. 59% of patients had excellent (&gt;90%) void filling, 26.4% of patients had 50-90% void filling, and 14.6% had &lt; 50% void filling. Normal bone cortical thickness was restored on AP and Lateral views in 55.8% of patients. No residual Cerement-G was seen on X-rays at the final follow-up in any of the patients. Conclusions Our results showed successful integration of Cerament-G with excellent void filling and normal cortical thickness achieved in more than half of the patients.

scholarly journals Critical Tectonic Limits for Geothermal Aquifer Use: Case Study from the East Slovakian Basin Rim

Resources ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 31
Author(s):  
Stanislav Jacko ◽  
Roman Farkašovský ◽  
Igor Ďuriška ◽  
Barbora Ščerbáková ◽  
Kristína Bátorová
Keyword(s):  
Heat Flow ◽  
Pannonian Basin ◽  
Open Fractures ◽  
Water Type ◽  
Geothermal Heat ◽  
The North ◽  
Heat System ◽  
Volcanic Chain ◽  
Saline Solutions

The Pannonian basin is a major geothermal heat system in Central Europe. Its peripheral basin, the East Slovakian basin, is an example of a geothermal structure with a linear, directed heat flow ranging from 90 to 100 mW/m2 from west to east. However, the use of the geothermal source is limited by several critical tectono-geologic factors: (a) Tectonics, and the associated disintegration of the aquifer block by multiple deformations during the pre-Paleogene, mainly Miocene, period. The main discontinuities of NW-SE and N-S direction negatively affect the permeability of the aquifer environment. For utilization, minor NE-SW dilatation open fractures are important, which have been developed by sinistral transtension on N–S faults and accelerated normal movements to the southeast. (b) Hydrogeologically, the geothermal structure is accommodated by three water types, namely, Na-HCO3 with 10.9 g·L−1 mineralization (in the north), the Ca-Mg-HCO3 with 0.5–4.5 g·L−1 mineralization (in the west), and Na-Cl water type containing 26.8–33.4 g·L−1 mineralization (in the southwest). The chemical composition of the water is influenced by the Middle Triassic dolomite aquifer, as well as by infiltration of saline solutions and meteoric waters along with open fractures/faults. (c) Geothermally anomalous heat flow of 123–129 °C with 170 L/s total flow near the Slanské vchy volcanic chain seems to be the perspective for heat production.

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