HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Webb, L. X. Articles by Laverty, D. Search for Related Content PubMed PubMed Citation Articles by Webb, L. X. Articles by Laverty, D.

The Contaminated High-Energy Open Fracture: A Protocol to Prevent and Treat Inflammatory Mediator Storm–Induced Soft-Tissue Compartment Syndrome (IMSICS)

Dr. Webb is Professor, Department of Orthopaedic Surgery, Wake Forest University Health Sciences, Winston-Salem, NC. Dr. Dedmond is Orthopaedic Traumatologist, Lexington Orthopaedics, West Columbus, SC. Dr. Schlatterer is Director, Orthopaedic Trauma, and Clinical Instructor, Department of Orthopaedic Surgery, Atlanta Medical Center, Atlanta, GA. Dr. Laverty is Orthopaedic Traumatologist, Austin Skeletal Trauma Specialists, Austin, TX.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Webb, Dr. Dedmond, and Dr. Laverty. Dr. Schlatterer or the department with which he is affiliated has received nonincome support (such as equipment or services) commercially derived honoraria, or other non-research–related funding (such as paid travel) from Smith and Nephew.

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.

This article has been cited by other articles:

				C. T. Born, S. M. Briggs, D. L. Ciraulo, E. R. Frykberg, J. S. Hammond, A. Hirshberg, D. W. Lhowe, P. A. O'Neill, and J. Mead Disasters and Mass Casualties: II. Explosive, Biologic, Chemical, and Nuclear Agents J. Am. Acad. Ortho. Surg., August 1, 2007; 15(8): 461 - 473. [Abstract] [Full Text] [PDF]