Wound care: From primary debridement to final reconstruction

Abstract

The goal of upper and lower extremity wound care and reconstruction is the coverage of defects and open wounds to give patients a healed wound and to let them resume their life, ambulate, and go back to work while preventing amputation. Open wounds and defects in the upper and lower extremity resulting from trauma are reconstructive challenges, especially when complicated by wound contamination, neurovascular injuries, bone defects, or comorbidities such as peripheral vascular disease and diabetes. These wounds need reconstruction for many reasons. First, any exposed bone that is not covered by vascularized soft tissue is at risk for osteomyelitis, bone necrosis, and sepsis. Osteomyelitis is a major cause of amputation in patients after trauma or patients with systemic diseases (Harris et al. J Orthop Trauma 23:1-6, 2009; Saddawi-Konefka et al. Plast Reconstr Surg 122:1796-1805, 2008; Scher and Steele Surgery 104:661-666 1988). Second, open wounds cause chronic pain, inability to ambulate, loss of hand function, significant medical expenses, and unemployment. Exposed tendons become dry and necrotic and exposed blood vessels are at risk for rupture. The following chapter will review the field of upper and lower extremity reconstruction, focusing on the repair of wounds sustained by severe trauma. We will concentrate on defects of the lower arm from elbow to hand and lower leg from knee to foot. Special attention will be paid to the nuances of wound preparation and the pitfalls to be avoided during this critical phase.