title: The contaminated high-energy open fracture: a protocol to prevent and treat inflammatory mediator storm-induced soft-tissue compartment syndrome (IMSICS).
abstract: 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.
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University Health Sciences, Winston-Salem, NC, USA.
authors.forename: Lawrence X
authors.initials: LX
authors.lastname: Webb
authors.forename: Barnaby
authors.initials: B
authors.lastname: Dedmond
authors.forename: Dan
authors.initials: D
authors.lastname: Schlatterer
authors.forename: David
authors.initials: D
authors.lastname: Laverty
mesh_terms: D003161:Compartment Syndromes / Q000209:etiology / Q000517:prevention & control*; D003646:Debridement / Q000379:methods*; D005597:Fractures, Open / Q000150:complications*; D006801:Humans; D011312:Pressure; D018461:Soft Tissue Infections / Q000150:complications / Q000517:prevention & control*; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing