开放性骨折的冲洗和清创原则是什么？

What are the principles of irrigation and debridement of open fractures?

开放性骨折的冲洗和清创原则是什么？

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Systematic debridement

- Start with removal of gross contamination, then layer by layer debridement

系统清创 

- 从去除明显的污染物开始，然后逐层清创。

Excise all necrotic tissue

- Muscle viability assessed with ‘the 4 Cs’ – color, contractility, capacity to bleed, consistency

切除所有坏死组织 

- 用“4C”评估肌肉活力 - 颜色、收缩性、出血能力、韧性。

Irrigate with saline at low pressure

- 3 litres for Gustilo type I, 6 litres for Gustilo type II and III

使用低压盐水进行冲洗 

- Gustilo I 型为 3 升，Gustilo II 型和 III 型为 6 升。

Limit tourniquet use

- Can add ischemic insult to already compromised tissue

- Limits ability to determine tissue viability

限制止血带的使用 

- 可能增加已受损组织的缺血性损伤 ，

- 限制确定组织活力的能力。

Repeat serial debridement in 48-72 hours in high energy injuries

高能量损伤后 48-72 小时内重复连续清创。

Wound closure

- Gustilo type I, II, IIIA = primary closure

- Gustilo type IIIB = alternate coverage

--Consider NPWT, antibiotic bead pouch covered by semi-permeable sterile dressing, Masquelet technique, or saline soaked gauze pack

-- Followed by definitive flap coverage

伤口闭合 

- Gustilo I、II、IIIA 型 = 一期闭合 ，

- Gustilo IIIB 型 = 替代覆盖 。

-- 考虑使用负压创面治疗 (Negative Pressure Wound Therapy, NPWT) 、用半透性无菌敷料覆盖的抗生素珠袋、Masquelet 技术或盐水浸泡的纱布包 ，

-- 随后进行确定性皮瓣覆盖。