MANAGEMENT AND THERAPEUTIC OUTCOME IN TYP E-IIIC OPEN FRACTURES ASSOCIATED WITH ARTERIAL INJURY

Ninety-one open fractures associated with arterial injury requiring va scular repair (type IIIC injuries) were treated at the University of L ouisville between May 1983 and January 1994. Involved anatomical areas were the humerus (6x), the forearm (11x), the femur (16x), the tibia (36x), the ankle (11x) and the foot (11x). Fracture management consist ed of meticulous radical debridement, copious wound irrigation, fascio tomy and fracture stabilization. Additionally, 49 wounds (53.8 %) were treated with the supplemental local use of antibiotics (tobramycin-PM MA-beads). Thirty-four patients underwent primary amputation whereas 5 7 repairs of the injured vessels were performed. There were 7 secondar y amputations due to infection or poor revascularization resulting in an overall amputation rate of 45.1 %. The wound infection rate was 12. 1 % (11/91) and the rate for osteomyelitis was 3.3 % (3/91). The local use of the antibiotic beads was of significant benefit to lower infec tious complications. Primary coverage of the soft tissue defect with f ree tissue transfer was associated with a high infection rate (2/3) an d is not recommended for this type of injury. Temporary wound coverage with the ''antibiotic bead pouch'' technique until wound closure can be obtained in a sterile and viable environment leads to more satisfyi ng results.