The Treatment Strategy for Infectious Traumatic Massive Soft Tissue Defect in Extremities

Abstract

Massive soft-tissue defects in extremities greatly increase the risk of infection. Repeated debridement and irrigation at 48-to 72-hour are vitally important for both prevention and treatment of infection. However, the appropriate times of debridement and irrigation before reconstructive surgery to minimize postoperative infection or to control an established infection have not been clarified. We collected and cultured tissue samples at the end of every surgical debridement of massive soft tissue defects with or without fractures in 9 patients. In seven of these 9 cases, the bacteria that were cultured from the wound completely disappeared after repeated debridement and irrigation and they did not show no deep tissue infection was shown, even two years after the wound closure using a free flap. Meanwhile, in two of the 9 cases, bacteria were cultured from the wound despite repeated debridement and irrigation. Unfortunately, these two cases showed deep tissue infection after reconstructive surgery. We demonstrated that repeated debridement and irrigation at 72-hour intervals until bacteria are not detected in a wound might be one of the most important indexes for appropriately deciding on the number of operations before reconstructive surgery to prevent or control infections in the extremities.