Classification and management of acute wounds and open fractures

• Published in: Surgery (Oxford) Vol. 41; no. 2; pp. 93 - 99
• Main Authors: Milne, Kirsty, Penn-Barwell, Jowan G.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.02.2023
• Subjects: Open fractures; reconstruction; trauma; wound infection; trauma; reconstruction; wound infection; Open fractures
• ISSN: 0263-9319; 1878-1764
• DOI: 10.1016/j.mpsur.2022.12.002

Open fractures and traumatic wounds represent a surgical challenge due to the risk of infection. At the extreme this is life and limb threatening but, more commonly, this limits options for reconstruction - which can have severe functional implications for a patient's rehabilitation. The treatment of these wounds requires removal of contamination and non-viable tissue in order to minimize further tissue damage, which has been covered by a series of guidelines developed by the British Orthopaedic Association. In high energy and complex wounds that are associated with fractures, treatment requires a combined Orthopaedic and Plastic Surgery approach. Initial surgical treatment is a priority and must involve senior surgeons from both specialties. This combined approach maximizes potential for reconstruction and rehabilitation while minimizing risk of infection and amputation; however, this combined approach also requires significant resources. These injuries should be managed in specialist centres, appropriately staffed and resourced, as facilitated by Major Trauma Centres.