Management of open fractures of the lower extremity.How vacuum sealing technique and external fixation affect the outcome.

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 vii 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.