Prevention of infections associated with combat-related extremity injuries

Clinton K. Murray, William T. Obremskey, Joseph R. Hsu, Romney C. Andersen, Jason H. Calhoun, Jon C. Clasper, Timothy J. Whitman, Thomas K. Curry, Mark E. Fleming, Joseph C. Wenke, James R. Ficke, Duane R. Hospenthal, R. Bryan Bell, Leopoldo C. Cancio, John M. Cho, Kevin K. Chung, Marcus H. Colyer, Nicholas G. Conger, George P. Costanzo, Helen K. CrouchLaurie C. D'Avignon, Warren C. Dorlac, James R. Dunne, Brian J. Eastridge, Michael A. Forgione, Andrew D. Green, Robert G. Hale, David K. Hayes, John B. Holcomb, Kent E. Kester, Gregory J. Martin, Leon E. Moores, Kyle Petersen, Evan M. Renz, Jeffrey R. Saffle, Joseph S. Solomkin, Deena E. Sutter, David R. Tribble, Andrew R. Wiesen, Glenn W. Wortmann

Research output: Contribution to journalReview articlepeer-review

99 Scopus citations

Abstract

During combat operations, extremities continue to be the most common sites of injury with associated high rates of infectious complications. Overall, ~15% of patients with extremity injuries develop osteomyelitis, and ~17% of those infections relapse or recur. The bacteria infecting these wounds have included multidrug-resistant bacteria such as Acinetobacter baumannii, Pseudomonas aeruginosa, extended-spectrum β-lactamase-producing Klebsiella species and Escherichia coli, and methicillin-resistant Staphylococcus aureus. The goals of extremity injury care are to prevent infection, promote fracture healing, and restore function. In this review, we use a systematic assessment of military and civilian extremity trauma data to provide evidence- based recommendations for the varying management strategies to care for combat-related extremity injuries to decrease infection rates. We emphasize postinjury antimicrobial therapy, debridement and irrigation, and surgical wound management including addressing ongoing areas of controversy and needed research. In addition, we address adjuvants that are increasingly being examined, including local antimicrobial therapy, flap closure, oxygen therapy, negative pressure wound therapy, and wound effluent characterization. This evidence-based medicine review was produced to support the Guidelines for the Prevention of Infections Associated With Combat-Related Injuries: 2011 Update contained in this supplement of Journal of Trauma.

Original languageEnglish (US)
Pages (from-to)S235-S257
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume71
Issue number2 SUPPL. 2
DOIs
StatePublished - Aug 2011
Externally publishedYes

Keywords

  • Afghanistan
  • Extremity
  • Infection
  • Iraq
  • Prevention

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Prevention of infections associated with combat-related extremity injuries'. Together they form a unique fingerprint.

Cite this