Temporary Wound Dressings

2020 ◽  
pp. 31-40
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Normal Saline ◽  
Negative Pressure ◽  
First Aid ◽  
Wound Dressings ◽  
Soft Tissue Reconstruction ◽  
Wound Therapy ◽  
Tissue Reconstruction ◽  
Wound Excision

Temporary dressings are used to cover the wound from the time of first aid through to definitive soft tissue closure. Frequent dressing changes should be avoided to reduce contamination by nosocomial organisms. Therefore, the initial dressing should be simple to apply and maintain tissue viability by preventing desiccation, e.g. gauze soaked in normal saline and covered with an occlusive film as per the National Institute for Health and Care Excellence guidance. Following wound excision, a simple non-adherent dressing can be used. Negative pressure wound therapy should not be used to downgrade the requirement for definitive soft tissue reconstruction, which should be achieved within 72 hours of injury. Following internal fixation, definitive soft tissue reconstruction should be performed at the same time.

Timing of Soft Tissue Reconstruction

2020 ◽  
pp. 57-62
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Free Flap ◽  
Soft Tissue Reconstruction ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Fracture Union ◽  
Patient Factors ◽  
Tissue Reconstruction ◽  
Wound Excision

Soft tissue cover of a meticulously and comprehensively excised (debrided) wound is the cornerstone of achieving infection-free fracture union. Planning of the soft tissue reconstruction should ideally occur at the time of wound excision. Definitive soft tissue reconstruction should be performed within 72 hours of the injury unless precluded by patient factors, and at the same time as internal fixation of the fracture. Free flap reconstruction is ideally performed on scheduled lists in specialist orthoplastic centres.

Soft Tissue Reconstruction

2020 ◽  
pp. 63-74
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Open Fractures ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Tissue Reconstruction ◽  
Wound Excision

Soft tissue coverage of open fractures with well-vascularised tissues should be performed within 72 hours of injury or at the same time as internal fixation. It may be in the form of local or free flaps, and may comprise muscle, fasciocutaneous tissues, or both. Flap selection depends on multiple factors, including the size and location of the defect following wound excision, availability of flaps, and donor site morbidity. Local flaps are usually used to cover defects with a limited zone of injury. Anastomoses for free flaps should be performed outside the zone of injury. Experimental data suggest that coverage with muscle leads to improved healing of fractures. However, there is currently little clinical evidence to support the use of one form of soft tissue cover over another for open fractures of the lower limb. The plastic surgeon must always consider the donor site morbidity of the flap(s) chosen.

scholarly journals Awkward defects around the elbow: The radial recurrent artery flap revisited

2016 ◽  
Vol 49 (03) ◽  
pp. 357-361
Author(s):  
Maksud M. Devale ◽  
Rohit P. Munot ◽  
Chirag A. Bhansali ◽  
Neeraj D. Bhaban
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Elbow Joint ◽  
Donor Site ◽  
Distal Humerus ◽  
Donor Site Morbidity ◽  
Soft Tissue Reconstruction ◽  
Posterior Aspect ◽  
Tissue Reconstruction ◽  
Radial Recurrent Artery

ABSTRACT Background: Soft tissue defects on the posterior aspect of the elbow are commonly seen in patients treated with internal fixation for fractures around the elbow joint. An axial flap based on the radial recurrent artery (RRA) is very useful for such defects, especially if a posterior midline arm incision has been taken for skeletal fixation. The aim of this study is to describe the usefulness of RRA flap (based on the RRA) in the management of such defects. Materials and Methods: We present a retrospective analysis of 4 cases managed with the RRA flap for soft tissue reconstruction of defects around the elbow joint at our institute from January 2015 to August 2016. All the patients were males with a history of exposed implant following internal fixation of olecranon/distal humerus fracture. The size of defects ranged from 4 cm × 4 cm to 7 cm × 5 cm. Results of the analysis are presented here. Results: All flaps survived completely. There was no infection, hematoma or distal neurovascular deficit. There was minimal donor site morbidity. Conclusion: The RRA flap is a useful, simple flap for defects around the elbow joint in select patients providing one stage, reliable, cosmetically acceptable coverage.

scholarly journals Effective Salvage Surgery of a Severely Congested Propeller Perforator Flap Using a Postoperative Delay Technique and Negative-Pressure Wound Therapy

2019 ◽  
Vol 19 (1) ◽  
pp. 86-88 ◽  
Author(s):  
Naohiro Ishii ◽  
Tomoki Kiuchi ◽  
Takahiro Uno ◽  
Yuichiro Uoya ◽  
Kazuo Kishi
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Salvage Surgery ◽  
Perforator Flap ◽  
Pressure Sore ◽  
Soft Tissue Reconstruction ◽  
Wound Therapy ◽  
Wound Edge ◽  
Tissue Reconstruction ◽  
Edge Based

Wound edge–based propeller perforator flaps have often been applied to soft tissue reconstruction of sacral pressure sores. Although this flap often causes necrosis due to overtension and twisting of the perforators, salvage surgery using a postoperative delay technique has not been reported thus far. In this article, we present a case in which we successfully reconstructed a sacral pressure sore using a wound edge–based propeller perforator flap. The flap caused severe congestion, which had a concern due to the potential wide-ranging flap loss; it was subsequently salvaged by an emergent delay procedure and negative-pressure wound therapy on day 2 postoperatively.

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