Prevention of Infections Associated With Combat-Related Extremity Injuries

Abstract

During combat operations, extremities continue to be the most common sites of injury with associated high rates of infectious complications. Overall, ∼ 15% of patients with extremity injuries develop osteomyelitis, and ∼ 17% of those infections relapse or recur. The bacteria infecting these wounds have included multidrug-resistant bacteria such as Acinetobacter baumannii, Pseudomonas aeruginosa, extended-spectrum β-lactamase-producing Klebsiella species and Escherichia coli, and methicillin-resistant Staphylococcus aureus. The goals of extremity injury care are to prevent infection, promote fracture healing, and restore function. In this review, we use a systematic assessment of military and civilian extremity trauma data to provide evidence-based recommendations for the varying management strategies to care for combat-related extremity injuries to decrease infection rates. We emphasize postinjury antimicrobial therapy, debridement and irrigation, and surgical wound management including addressing ongoing areas of controversy and needed research. In addition, we address adjuvants that are increasingly being examined, including local antimicrobial therapy, flap closure, oxygen therapy, negative pressure wound therapy, and wound effluent characterization. This evidence-based medicine review was produced to support the Guidelines for the Prevention of Infections Associated With Combat-Related Injuries: 2011 Update contained in this supplement of Journal of Trauma.

«Damage control» – choice technology for reduction of mortality and complications after military surgical trauma

“…The third stagere-operation and the fi nal surgical correction of all injuries. [7]. Після тампонування живота і закриття лапа-ротомної рани за допомогою хірургічних ца-пок протягом 30-60 хвилин спостерігають за хворим в операційній, а потім повторно від-кривають черевну порожнину і видаляють ча-стину тампонів.…”

“…Наприклад, етапне лікуван-ня у семи пацієнтів із тяжкими пораненнями By the proposed M.Rotondo et al It is advisable to add another three-stage technologya reassessment of hemostasis, as suggested by E.Moore [7]. After tamponing the abdomen and closing laparotomy wounds with surgical bass for 30-60 minutes, observe the patient in the operating room, and then re-open the abdominal cavity and remove part of the tampons.…”

“…Така різниця в показниках по-яснюється різною підготовкою військових, різними видами зброї та засобами захисту. Проникаючі поранення і закрита травма живота -найтяжчий компонент бойової травми, який негативно впливає на резуль-тати лікування поранених і травмованих бійців [6,7].…”

“…This difference in the rates is explained by the different training of the military, various types of weapons and means of protection. Penetrating injuries and closed abdominal trauma is one of the most serious components of a traumatic injury, which adversely affects the outcome of the treatment of wounded and injured soldiers [6,7].…”

d-amino Acid Inhibits Biofilm but not New Bone Formation in an Ovine Model

“…Infectious complications are an important factor contributing to patient morbidity and limiting the success of clinical management of complex trauma [9,32,36]. Treatment of bone infections in patients with fractures can involve operative débridement of necrotic bone followed by several weeks of systemic antibiotics, temporary fixation, and/or implantation of devices to promote bone regeneration [11,44].…”