The contaminated high-energy open fracture: a protocol to prevent and treat inflammatory mediator storm-induced soft-tissue compartment syndrome (IMSICS)

J Am Acad Orthop Surg. 2006;14(10 Spec No.):S82-6. doi: 10.5435/00124635-200600001-00019.

Abstract

The treatment modalities currently used in surgical débridement leave the traumatic wound with viable but tenuous tissue and a variable level of microcontaminants potentially laden with bacteria. In high-energy contaminated wounds, retention of these contaminants within the tenuous tissue of the so-called zone of stasis can result in further tissue necrosis and the development of infection. A novel protocol for managing the high-energy contaminated open fracture involves two new techniques. First, Bernoulli's principle is used to facilitate a systematic excision of contaminants, as well as the wound surface to which they are adsorbed, by means of a high-velocity fluid stream. Second, topical negative pressure is established as a means to resuscitate the remaining edema-laden wound tissue to help avoid embarrassment to microcirculatory blood flow.

Publication types

  • Review

MeSH terms

  • Compartment Syndromes / etiology
  • Compartment Syndromes / prevention & control*
  • Debridement / methods*
  • Fractures, Open / complications*
  • Humans
  • Pressure
  • Soft Tissue Infections / complications
  • Soft Tissue Infections / prevention & control*
  • Therapeutic Irrigation / methods
  • Treatment Outcome
  • Wound Healing