The Evolution and Interpretation of the Gustilo and Anderson Classification.

BACKGROUND: The Gustilo classification is the most established system for classifying open fractures. Despite this, the classification has changed in how it has been described and interpreted. We have traced how this classification has slowly evolved throughout the literature over the past 4 decades. METHODS: A systematic search of the literature was undertaken with the MEDLINE, Embase, and PubMed databases to source relevant articles that have evolved the interpretation of the Gustilo classification. The references from these articles were consecutively hand-searched to find other articles that describe the Gustilo classification. RESULTS: There was a total of 393 results from the Healthcare Databases Advanced Search (HDAS): 95 from MEDLINE, 49 from Embase, and 249 from PubMed. Fifty-six articles were initially selected; an additional 67 articles were retrieved through reference checking and further checking of relevant articles until no additional relevant articles could be found. CONCLUSIONS: The original Gustilo and Anderson classification initially was modified by Gustilo before subtle changes were made to the descriptors in the 1990s. Some authors have used the Gustilo classification to create alternative classifications, but these have not gained traction. Other contemporaneous literature has modified the Gustilo-IIIB subtypes to better stratify functional and reconstructive outcomes following vascular injury. The impact and longevity of such recent modifications are yet to be known.

The WoundWand and Its Novel Use in Burn Excision Surgery.

OBJECTIVE: The authors present the novel use of a new generation surgical ablative tool known as the WoundWand. METHODS: A 66-year-old woman presented with 18% deep-dermal and full-thickness burns affecting the left side of her body including the total left upper limb, abdomen, and left thigh following lighting a cigarette in bed while on home oxygen therapy. She underwent tangential excision of burn using the WoundWand with immediate reconstruction using split skin grafts and topical negative pressure therapy. RESULTS: We found that we were able to easily tangentially excise the hard eschar from delicate areas such as the hand and fingers using the WoundWand. DISCUSSION: The authors conclude that the novel use of this device particularly in delicate areas such as dorsum of fingers and hand has some advantages over preexisting methods. Further clinical study may add to the surgical armamentarium of the burns surgeon.