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Soft tissue management of open fractures: Update 2016

Trauma und Berufskrankheit, ISSN: 1436-6282, Vol: 18, Issue: 1, Page: 16-21
2016
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Article Description

Background: Open fractures continue to be a challenge to orthopedic trauma surgeons and controversies with respect to best clinical practice are common. Meticulous management of soft tissue damage is of particular importance to achieve the optimal course; however, many treatment protocols lack evidence-based data. Methods: The authors performed a critical review of the literature involving recommendations on the management of soft tissue damage in open fractures. Studies were selected based on their relevance to clinical treatment of open fractures. Results: A total of 29 studies were included. The review focused on timing of initial débridement, time until wound closure, utilitization of negative pressure wound therapy (NPWT), the necessity for plastic surgery and and administration of antibiotics in the therapy of open fractures. Conclusion: Open fractures require urgent debridement. Timely wound closure dependent on successful removal of all necrotic tissue decreases the rate of complications. A calculated short-term administration of antibiotics is essential to avoid infections. Finally, despite the utmost importance of NPWT in the treatment of wounds associated with open fractures, flap coverage of tissue defects remains an integral component of the limb salvage algorithm.

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