Classification and management of acute wounds and open fractures

• Published in: Surgery (Oxford) Vol. 38; no. 3; pp. 143 - 149
• Main Authors: Milne, Kirsty E, Penn-Barwell, Jowan G.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.03.2020
• Subjects: Open fractures; reconstruction; trauma; wound infection; trauma; reconstruction; wound infection; Open fractures
• ISSN: 0263-9319; 1878-1764
• DOI: 10.1016/j.mpsur.2020.01.010

Open fractures and traumatic wounds represent a surgical challenge due to the risk of infection. At the extreme this is life and limb threating, but more commonly, it limits the options for reconstructions which can have functional implications for a patient. The treatment of these wounds requires removal of contamination and non-viable tissue in order to minimize further tissue damage. A wound bed of healthy tissue is essential for microbial eradication. In high energy and complex wounds associated with fractures, treatment requires a combined orthoplastic approach. Initial surgical treatment is an urgent priority and must involve senior surgeons from both specialties. This combined approach maximizes potential for reconstruction and rehabilitation while minimizing risk infection and amputation. However, this combined approach requires significant resources. Therefore, these injuries should be managed in appropriately staffed and resourced specialist centres, in practice this normally means treatment in a major trauma centre.