JOURNAL ARTICLE
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Efficacy of hydrosurgical debridement and nanocrystalline silver dressings for infection prevention in type II and III open injuries.

The aim of this study was to retrospectively evaluate the clinical and culture-positive infection rates of open Gustilo/Anderson type II and III fractures using a protocol nanocrystalline silver wound dressing and hydrosurgical debridement. Retrospective case series through chart review on all type II and III open fractures were treated using a novel protocol from December 2005 to March 2008 (N = 17). All Gustilo/Anderson grade II and III open fractures were treated with a novel protocol at a Level I trauma centre. Open Gustilo/Anderson grade II and III fractures were acutely stabilised in the trauma centre/emergency department, while a nanocrystalline silver dressing was placed within the wound. Debridement using a hydrosurgical scalpel and gravity irrigation was performed within 6-8 hours of injury. Cultures were obtained prior to definitive fixation. The primary outcome measurements were positive cultures and clinical infection rates. Seventeen patients met inclusion criteria. Mean age (33·5) and injury severity score (12·7) were gathered. There were 4 grade II open fractures (23·5%), 11 grade IIIA (64·7%) and 2 grade IIIB open fractures (11·8%). The mean time to intravenous antibiotics was 61·5 minutes. The mean time to initial debridement/irrigation was 222·1 minutes. The average number of surgical procedures was 2·35 with a mean length of stay of 11·8 days. Six patients developed positive cultures from the traumatic wounds, five were contaminants. One clinical infection was found (methicillin-resistant Staphylococcus aureus). The overall clinical infection rate in this series was 5·9% (1/17). The only infection was in a Gustilo/Anderson grade II fracture. There were no infections in the more high-energy Gustilo/Anderson grade IIIA and IIIB fractures compared with the Gustilo/Anderson control of 4-42%. We conclude that this novel protocol for open-fracture treatment is a promising intervention. A further prospective randomised clinical study is warranted.

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