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VSD for Treating Open Fracture

How about VSD is used for treating open fracture?

Answer: We mainly introduced the treatment of serious open fracture. Main procedures of treating open fracture (Gustilo III): 1. Debridement; 2. External fixation of bone fracture; 3. Examination of blood vessel, and corresponding examination should be taken for vascular injury. Examination and treatment on nerves should be also taken. 4. Incision of fascia compartment to reduce pressure. 5. Wound surface was treated with VSD. Notes: Take debridement according to specific condition of injury. After corresponding fixation on bone fracture, measures were taken to prevent osteofascial compartment syndrome; VSD materials were placed on wound surface, or at the place with bone exposure according to condition of injury, and VSD was taken. We should pay attention to: during design and placing VSD materials, it should avoid improper place of materials, which can compress blood vessel, nerves and skin, and induce tissue necrosis. It is better to place materials along vascular direction and skin texture.

What are the common complications of open fracture?


1. Infection

2. Thrombosis

3. Muscular and soft tissue necrosis

4. Blood injury and nerve damage

5. Osteofascial compartment syndrome

6. Delayed fracture healing or un-healing (bone un-union)

What is the infective rate of open fracture?

Type I 2 %

Type II 7 %

Type IIIA 7 %

Type IIIB 10-50 %

Type IIIC 20-50 %

Infective rate is varied in accordance with Gustilo types. The results come from literatures in JBJS (Journal of Bone and Joint Surgery--American), which is the most praised information source by orthopedists and researchers in the past 100 years, and also the golden standard for peer reviewed scientific information in the filed of orthopedics.  

What are Gustilo types?

Answer: Gustilo types of open fracture

Type I: Wound size is less than 1 cm, and mostly are clear puncture wounds. Bone tip got through skin, soft tissue injury was slight, and there was without contused injury. The bone fracture was simple, mostly in transverse type or short oblique type, and without crushing.

Type II: Wound size is more than 1 cm, soft tissue injuries are wide, and there was without formation of tissue flap. Soft tissues were with slight or moderate crushing injury, wound was with moderate infection and crushing fracture.

Type III: Soft tissue injury was wide, including serious infection of muscle, skin, blood vessel and nerve. 

Type IIIA: There were wide avulsion injury and formation of tissue flap, or high energy injury. No matter how big is the size of wound, bone fracture area should be covered with soft tissues.

Type IIIB: There were wide soft tissue injury and defect, periosteal stripping, bone exposure and severe infection.

Type IIIC: Concomitant with artery injury requiring recovery. 

What are the principles for treating open fracture?

Answer: Take timely and proper wound treatment to prevent from infection, change open fracture to close fracture (Surgery in General Practice, the 7th Edition)

What is the biggest risk for open fracture?

Answer: Wound is infected and invaded by lots of bacterium, which can reproduced quickly and induce bone infection (Surgery in General Practice, the 7th Edition)

What should be paid attention to for treating open fracture with VSD?

Answer: External fixation is pasted and sealed, in order to prevent air leakage; preventive rinse can prevent blockage; it needs to observe wound and prevent active bleeding.