How long can secondary resurfacing surgery be delayed with continuous irrigation therapy for gustilo-anderson type iii fracture? A retrospective clinical study

Abstract

Background: The resurfacing of Gustilo–Anderson (GA) IIIB and C fractures remains challenging. Immediate debridement and external stabilization of the fracture followed by early internal fixation along with wound closure using flaps are recommended. Although it requires early soft tissue reconstruction, it is not always possible. We considered that continuous wound irrigation might reduce the chance of infection and extend the delay period until the secondary surgery. Patients and Methods: A total of 19 patients with GA IIIB and C fractures who underwent debridement and external fixation were evaluated. Among them, 18 cases were examined, excluding one who received amputation. Ten underwent wound-resurfacing surgery within 10 days after injury, and the other 8 did so after 11 days. We examined the frequency of osteomyelitis development depending on the timing of wound closure and predicted how long secondary wound closure surgery could be delayed on the application of continuous irrigation therapy. Results: Eight patients developed osteomyelitis. The number of days until wound closure in the group that developed osteomyelitis was significantly greater than in those who did not develop osteomyelitis group (P < 0.05). Only one patient (10%) developed osteomyelitis in the early resurfacing group, while 7 (87%) did so in the late resurfacing group. There was a significant difference between the groups (P < 0.01). Conclusion: This study showed that that the continuous irrigation method could extend the delay time until the secondary surgery for GA III fractures. However, it suggested that the waiting should be limited to a maximum of 10 days.

Keywords

• fix and flap
• gustilo-anderson iii fracture
• open fracture
• osteomyelitis
• soft tissue coverage
• wound closure
• wound irrigation