- Technical Considerations:
- consider debriding the wound with a separate set of surgical instruments / drapes
- exposure: extend the traumatic incision longitudinally inorder to fully expose zone of injury;
- pressure irrigation:
- debridement of open tibia fractures:
- arguments for leaving wound open:
- traditionally, the surgeon will close surgical incisions made during the case but will leave the traumatic wound open;
- adresses compartment syndrome (if there is a concern)
- relief of skin tension
- leaving the wound open maximizes drainage and wound tension (which is frequently present w/ primary closure);
- at 2nd look debridement (at 48-36 hrs), the edema will have diminished and the wound can be closed w/ less tension;
- alternatively if the wound cannot be closed tension free then soft tissue reconstruction is needed;
- ability to redebride devitalized muslce and tissue;
- ability to remove additional contaminants;
- references:
- Primary or delayed closure for open tibial fractures.
- Compartment syndrome in open tibial fractures.
- arguments for primary wound closure:
- note that the most frequently identified organisms in open tibial fractures are staph aureus and nocosomial organisms;
- leaving the wound closed allows easier examination of the extremity during the postoperative period;
- if there is a concern about wound tension, then consider making a limited posteromedial relaxing incision;
- this allows a proplyatic fasciotomy and yet this incision will be away from the fracture site to avoid fracture nocosomial contamination;
