Amna Diwan,Kyle R. Eberlin,Raymond Malcolm Smith.[J].中华创伤杂志英文版,2018,21(4):187-192
The principles and practice of open fracture care, 2018
KeyWord: Open fracturesDebridementBony stabilizationEarly healthy soft tissue cover
Author NameAffiliation
Amna Diwan University of Massachusetts Medical School, Department of Orthopedics and Rehabilitation, UMASS Memorial Medical Centre, Worcester, MA, USA 
Kyle R. Eberlin Department of Surgery, Harvard Medical School, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA 
Raymond Malcolm Smith Department of Orthopaedics, Harvard Medical School, Chief Orthopaedic Trauma Service, Massachusetts General Hospital, Boston, MA, USA 
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      The principles of open fracture management are to manage the overall injury and specifically prevent primary contamination becoming frank infection. The surgical management of these complex injuries includes debridement & lavage of the open wound with combined bony and soft tissue reconstruction. Good results depend on early high quality definitive surgery usually with early stable internal fixation and associated soft tissue repair. While all elements of the surgical principles are very important and depend on each other for overall success the most critical element appears to be achieving very early healthy soft tissue cover. As the injuries become more complex this involves progressively more complex soft tissue reconstruction and may even requiring urgent free tissue transfer requiring close co-operative care between orthopaedic and plastic surgeons. Data suggests that the best results are obtained when the whole surgical reconstruction is completed within 48-72 h.
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