Key aspects of soft tissue management in fracture-related infection: recommendations from an international expert group

Author:

Marais Leonard C.,Hungerer Sven,Eckardt Henrik,Zalavras Charalampos,Obremskey William T.,Ramsden Alex,McNally Martin A.,Morgenstern Mario,Metsemakers Willem-JanORCID,Obremskey William T.,McNally Martin A.,Atkins Bridget L.,Borens Olivier,Depypere Melissa,Egol Kenneth A.,Fragomen Austin T.,Onsea Jolien,Govaert Geertje A. M.,Kates Stephen L.,Kuehl Richard,Mcfadyen Ian,Fintan Moriarty T.,Raschke Michael,Richards R. Geoff,Sancineto Carlos,Senneville Eric,Trampuz Andrej,Verhofstad Michael H. J.,Zimmerli Werner,

Abstract

AbstractA judicious, well-planned bone and soft tissue debridement remains one of the cornerstones of state-of-the-art treatment of fracture-related infection (FRI). Meticulous surgical excision of all non-viable tissue can, however, lead to the creation of large soft tissue defects. The management of these defects is complex and numerous factors need to be considered when selecting the most appropriate approach. This narrative review summarizes the current evidence with respect to soft tissue management in patients diagnosed with FRI. Specifically we discuss the optimal timing for tissue closure following debridement in cases of FRI, the need for negative microbiological culture results from the surgical site as a prerequisite for definitive wound closure, the optimal type of flap in case of large soft tissue defects caused by FRI and the role of negative pressure wound therapy (NPWT) in FRI. Finally, recommendations are made with regard to soft tissue management in FRI that should be useful for clinicians in daily clinical practice.Level of evidence Level V.

Funder

AO Foundation

Publisher

Springer Science and Business Media LLC

Subject

Orthopedics and Sports Medicine,General Medicine,Surgery,Surgery

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