Abstract:
Vacuum
sealing technique and external fixation system affect the outcome.
SUBJECT: Patients with fractures of the lower extremity in whom thorough wound
debridement, copious irrigation, vacuum sealing application and
external fixation was the main stay of treatment.
OBJECTIVE:To study and analyse the quality of various operative management of
soft tissues and skeletal injuries of the lower extremity.
SUMMARY:
Amputation has been the main stay of treating open fractures up to the
middle of the 19th century. This had resulted in considerable disability and
great missery,especially in developing countries in terms of poor rehabilitation,
and problems of prosthesis procurement. High infection rate, prolonged healing
, times and hospital stay, have greately hindered a normal 'life in victims with
severe open fractures. echnology development in the western community
today, has tremendously revolutionised open fracture treatment not only from
amputation to limb salvage but also development of methods which prevent or
lower infection rate, achieve short healing time short, duration of hospital stay,
as well as short occupational re-intergration time.
Among 116 patients studied at the Traumatology department of the
University ofUlm Germany, about 90% were treated by serial vacuum sealing
after standard and serial debridement with thorough irrigation. Prophylactic
antibiotic (cefuroxime) was administered to all patients and external fixation
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was performed in 30% of patients, of which 16% were the Ilizarov ring
fixation. Under the above protocol, the overall amputation rate was as low as
6%. It is concluded that the above protocol of open fracture treatment is
associated with a high rate of limb salvage, low complication rate, short healing
time and short duration of hospital stay. That undeniable fact outweighs the
relatively expensive procurement of such surgical material necessary to establish
this important protocol at the Muhimbili Orthopedic Institute.
