New Alternative Therapeutic Strategy for Gustilo Type IIIB Open Fractures, Using an Intra-Wound Continuous Negative Pressure Irrigation Treatment System.

The treatment of Gustilo type IIIB and IIIC open fractures remains a challenging problem, because the infection rate is 15-45%. Infection can lead to serious complications such as osteomyelitis or amputation. The intra-wound continuous negative pressure and irrigation treatment (IW-CONPIT) was developed for infected wounds and intractable ulcers, and is very effective in suppressing infection and accelerating wound healing. Here the IW-CONPIT was applied to severe open fractures for the purpose of preventing infection. After thorough debridement and lavage of the wound, bony stabilization is performed by external fixation. Dermal matrix is grafted onto any areas where the bone or tendon is exposed. A sponge containing two tubes is placed over the entire surface of the wound including the dermal matrix. Then it is covered with a film dressing to make the wound completely airtight. A bottle of physiologic saline solution is attached to one tube, and a continuous aspirator is attached to the other. This system maintains negative pressure on the wound surface, which is continuously irrigated. Thirty-five patients were treated with this method. A superficial infection developed in two cases but was resolved by additional debridement and continued application of IW-CONPIT. Complete wound healing was obtained with split thickness skin graft in all cases. There were no complications such as osteomyelitis, delayed bone union or amputation. IW-CONPIT was able to definitively prevent wound infection in Gustilo type ⅢB open fractures. We believe this method will become a standard treatment option for this condition.

Hyperbaric oxygen therapy in the treatment of open fractures and crush injuries.

This article focuses on the use of hyperbaric oxygen therapy (HBOt) in the treatment of open fractures and crush injuries. Based on the clinical evidence and cost analysis, medical institutions that treat open fracture and crush injuries are justified in incorporating HBOt as a standard of care. Both Medicare and Undersea and Hyperbaric Medical Society guidelines list crush injuries as an approved indication for HBOt. Emergency physicians should familiarize themselves with this emerging treatment modality because of their role in the early management of these injuries.

[Hyperbaric oxygenation in the treatment regimen using Ilizarov technique in patients with open fractures]. / Giperbaricheskaia oksigenatsiia v sisteme lecheniia po metodu Ilizarova bol'nykh s otkrytymi perelomami.

The dynamics of clinico-physiological parameters in complex treatment of patients with open fractures of the extremities using hyperbaric oxygenation was analyzed in 22 patients with severe injuries with different degree of ischemia of the extremity, and 9 patients with scanty injuries of the soft tissues. It was shown that vasospasm was observed in patients with the initially normal microcirculation after a course of HBO treatment. In patients with no or initially low capillary blood flow the microcirculation was enlarged due to vasodilatation of the arterioles. No considerable effects of the course of HBO on the main blood flow was revealed. Recommendations are given on using the HBO therapy in management of patients with severe open fractures and osteosynthesis of the injured segment by the Ilizarov methods.

[The optimization of bone repair in open comminuted fractures of the long bones]. / Optimizatsiia osteoreparatsii pri otkrytykh mnogooskol'chatykh perelomakh dlinnykh kostei.

Clinical and experimental researches were conducted to study the possibilities for enhancing the efficiency of treatment of open composite comminuted and crushed fractures of long bones with the help of repercussive action of electrets. The results of roentgenomorphometric, clinical and biomechanical researches have shown the efficiency of electrets that could shorten the healing time of the infected wounds, stop the inflammatory reaction and promote the repairing process of bones. The application of electrets using the repercussive methods in complex treatment of complicated open fractures in cases with multiorgan and concomitant injuries creates favourable conditions for the healing process. This method is simple, atraumatic and economical.

[Hyperbaric oxygenation in the prevention of wound infection in open injury to the locomotor apparatus]. / Giperbaricheskaia oksigenatsiia v profilaktike ranevoi infektsii pri otkrytoi travme oporno-dvigatel'nogo apparata.

Hyberbaric oxygenation in altitude chambers OKA-MT was used in the complex of prophylactic measures against wound infection in 91 patients with open traumas of the extremities (fractures, amputations, etc.). The effect of hyperbaric oxygenation on the external respiration was studied by the method of spirography. Tetrapolar rheography was used to follow the central hemodynamics. A number of immune parameteres were also studied. Hyperbaric oxygenation was established to abolish hyperventilation and myocardium hyperdynamia, to accelerate the recovery of the neutrophil phagocytic activity and immunoglobulin level, to contribute to the quicker diminishing of edema in the wound area and healing of the stump and open fracture without suppuration, early formation of dry necrosis with a distinct line of demarcation.