PRIMARY CLOSURE OF COMPOUND-FRACTURE WOUNDS

With Immediate Internal Fixation, Immediate Skin Graft, and Compression Dressings

¹ ERIE, PENNSYLVANIA

A series of 150 consecutive compound fractures has been treated by primary suture, partly with and partly without the advantage of the bacteriostatics, a blood bank, and a high-protein diet.

In respect to wound healing, bony union, prompt restoration of function, and the salvaging of extremities, the results have been superior to those obtained by previous methods.

Improved results are attributed, first, to the compression dressing; second, to immediate coverage of the surface defect with skin or a split-skin graft; and third, to immediate or delayed internal hairline reduction, with metallic fixation when indicated.

The hazard of primary suture is greatly reduced by penicillin and the availability of whole blood. Healing by first intention has been more frequent since the adoption of more radical excision of partly or wholly devitalized skin flaps. Temporary removal of the tourniquet has been found to be the only dependable aid in evaluating the vitality of the skin.

A thorough knowledge of and versatility in skin-plastic surgery are important for selection of the optimum covering of the individual skin defect. Preference is given to the approximation of relaxed flaps, whenever possible. Defects caused by relaxing incisions are covered, immediately or later, by split grafts.

Evaluation of the end results of compound fractures is facilitated by photographs of the external wound, made at the time of the usual admission roentgenogram, and repeated two weeks later at the time of the first dressing.

An attempt has been made to evaluate the therapeutic indications of each case on admission and to determine the factors which require immediate treatment. Definitive fracture treatment should frequently be postponed. It is usually advantageous to carry out simultaneously the treatment of shock and a careful débridement, followed immediately by elosure of the skin and the application of a compression dressing.

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