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Contaminated Wound Care

-  See:
        - Pressure Irrigation 
        - Topical Agents and Antiseptics

- Management:
    - antibiotic bead pouch:
           - after stabilization has been completed, osseous defects may be filled w/ antibiotic-impregnated methylmethacrylate beads;
           - these are made by the mixing of 1.2 to 2.4 grams of tobramycin or one to two grams of vancomycin, or both, with one package (forty grams) of methylmethacrylate over braided 26-gauge wire;
           - these beads provide local depot administration of antibiotic and maintain a space for subsequent bone graft;
    - drains and closure of wounds:
           - traditionally all traumatic wounds, including those created by fasciotomies, are left open for 48 hrs;
           - operative incisions may be sutured closed if doing so does not produce undue tension at the skin edge;
           - exposed tendons, joints, and bone should be covered w/ adjacent soft tissue to prevent desiccation;
    - wound dressings:
           - temporary coverage of exposed tissue was often obtained in the past by placement of sterile dressing sponges soaked in isotonic saline solution over the wound, but this leads to wound desiccation;
           - wound vac is now widely used for a variety of traumatic wounds;
           - alternatives, such as pigskin, Epigard, etc.

Comparison of soap and antibiotic solutions for irrigation of lower-limb open fracture wounds. A prospective, randomized study. 

Primary closure of the contaminated wound. Closed suction wound catheter.

Studies in the management of the contaminated wound. VI. The therapeutic value of gentle scrubbing in prolonging the limited period of effectiveness of antibiotics in contaminated wounds.

Studies in the management of the contaminated wound. I. Optimal time for closure of contaminated open wounds. II. Comparison of resistance to infection of open and closed wounds during healing.

Primary versus delayed soft tissue coverage for severe open tibial fractures. A comparison of results.

Misc articles:

Proteolytic enzymes as adjuncts to antimicrobial prophylaxis of contaminated wounds

Side-effects of topical proteolytic enzyme treatment

Mechanisms by which proteolytic enzymes prolong the golden period of antibiotic action

Delayed wound closure based on bacterial counts
Quantitative bacteriology and delayed wound closure
The reclosure of postoperative incisional abscesses based on bacterial quantification of the wound

Closure of contaminated wounds. Biologic and technical considerations. 

Investigation of a biodegradable, implantable antibiotic delivery system on rate of wound infection

Successful treatment of chronically infected wounds with sugar paste

Treatment of cutaneous abscess: a double-blind clinical study

Cutaneous abscesses: natural history and management in an outpatient facility

Antibiotics in surgical treatment of acute abscesses

The treatment of acute superficial abscesses: a prospective clinical trial

Treatment of acute abscesses by incision, curettage and primary suture without antibiotics: a controlled clinical trial

Antimicrobial treatment of minor soft tissue lacerations: a critical review

A rapid method of performing quantitative wound cultures