Timing of debridement: When to do it, and who should perform it?

IF 2.2 3区 医学 Q3 CRITICAL CARE MEDICINE
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Abstract

The timely and effective management of open fractures continues to be a challenge in modern orthopaedic practice. Lower limb high energy fractures with complex soft tissue injuries require multi-disciplinary care to achieve the best results. Despite an extensive published literature on open fractures, the timing of debridement and the most appropriate personnel to perform it continue to be a source of debate. National guidelines on the topic are few but they suggest immediate debridement for open fractures with highly contaminated wounds and debridement within 12 to 24 h is considered desirable for less contaminated wounds. There is actually limited evidence linking timing of debridement to infection risk but the largest studies recently published do indicate a link between delay to debridement and increasing infection risk. Most studies on management are based on a clinical model where the initial debridement and fixation are performed by an orthopaedic surgeon and if required delayed coverage and closure is subsequently carried out by a plastic surgeon. More recently, studies have proposed an alternative approach, with initial debridement and temporary fixation followed within 48 h with a further debridement, definitive fixation and flap cover with a combined orthoplastic team. Reported results have been favourable. This is a significant change in management and there are limited data at present to determine if this approach will improve results in the most complex open fractures.
清创的时机:何时进行,由谁进行?
及时有效地处理开放性骨折仍然是现代骨科实践中的一项挑战。下肢高能量骨折伴有复杂的软组织损伤,需要多学科护理才能达到最佳效果。尽管已出版了大量有关开放性骨折的文献,但清创的时机和最合适的清创人员仍是争论的焦点。有关该主题的国家指南很少,但它们建议对伤口污染严重的开放性骨折立即进行清创,而对污染较轻的伤口最好在 12-24 小时内进行清创。实际上,将清创时间与感染风险联系起来的证据很有限,但最近发表的最大规模的研究确实表明,清创延迟与感染风险增加之间存在联系。大多数关于伤口管理的研究都是基于一种临床模式,即由整形外科医生进行最初的清创和固定,如有需要,再由整形外科医生进行延迟覆盖和缝合。最近的研究提出了另一种方法,即由整形外科联合团队在 48 小时内进行初步清创和临时固定,然后再进行进一步清创、明确固定和皮瓣覆盖。据报道,这种方法效果良好。这是一种重大的管理变革,目前只有有限的数据可以确定这种方法是否能改善最复杂的开放性骨折的治疗效果。
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来源期刊
CiteScore
4.00
自引率
8.00%
发文量
699
审稿时长
96 days
期刊介绍: Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.
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