• Journal of Chest Surgery
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• v.28 no.4
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• pp.360-364
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• 1995

Between January 1984 and January 1994, 13 patients developed mediastinitis after cardiac operations. There were 7 women and 6 men with a mean age of 24.2 years[range 0.7 - 61 . Initial operation included 7 valve replacements and 6 congenital cardiac repairs. The duration between initial operation and diagnosis was 13.5 days[range 4-57 . Organisms cultured from debridement material included S.aurus[n=9 , S.epidermidis[n=3 and Enterobacter[n=1 . Fever was the most frequent complaint and purulent drainage was noticed in 9 patients[69% . Seven patients were treated with radical debridement followed by closed irrigation. In other 6 patients, the wounds were managed by debridement, open granulation and delayed wound closure. Two hospital deaths [15.4% following open granulation method, resulted from sepsis. The 11 survivors were followed-up for 1-120 months, averaging 42 months and had healed wounds. One late death occurred due to massive hemorrhage.

• Journal of Trauma and Injury
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• v.34 no.2
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• pp.105-111
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• 2021

Purpose: Open extremity fractures require prompt antibiotic medication and initial debridement surgery to reduce the infection rate and restore functional stabilization. We aimed to report the effects and positive outcomes of a trauma team approach on the management of open extremity fractures in polytrauma patients. Methods: This retrospective review included all polytrauma patients with open extremity fractures admitted between March 2009 and December 2019. Patients were divided into two groups according to whether they were treated before or after the implementation of the trauma team approach (March 2014). We analyzed the outcomes in each group with respect to the time interval until the doctor's arrival, total length of stay in the emergency department, the time interval until initial antibiotic treatment and operation, whether the initial operation was performed within 24 hours, and the rate of deep infections. Results: A total of 123 patients met the inclusion criteria. There were no statistically significant differences in demographic characteristics. The time interval until the doctor's arrival (64.12±49.2 minutes vs. 19.82±15.23 minutes; p=0.035) and initial antibiotic treatment (115.47±72.12 minutes vs. 48.78±30.12 minutes; p=0.023) significantly improved after implementing the trauma team approach. The union rate was not significantly different. However, the time interval until initial debridement, opportunity for initial debridement within 24 hours, and the rate of deep infections demonstrated better results. Conclusions: The reduced time interval until initial antibiotic treatment and debridement could be attributed to the positive effect of the trauma team approach on the management of open extremity fractures in polytrauma patients.

• Journal of Korean Foot and Ankle Society
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• v.8 no.1
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• pp.76-80
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• 2004

Purpose: We assessed the results of open treatment of anterior impingement syndrome of the ankle in elite level soccer players and concomitant injuries were idenfied. Materials and Methods: We retrospectively reviewed twenty one elite level soccer players diagnosed with anterior impingement syndrome who underwent open debridement between January 1997 and January 2002. All were men and the mean age at the operation was 21 years (range 16 to 27). The mean follow-up duration was 31 months (13 to 71). Concomitant abnormalities were idenfied through physical examination, bone scan and MRI. On a preoperative lateral radiograph, patients were classified according to McDermott's stage. Anteromedial or anterolateral approach was used at the operation and osteophyte was removed with osteotome and rongeur. When chronic ankle instability was accompanying, we performed Modified Brostrom-Gould procedure and for osteochondral lesion, multiple drilling was applied. The Ogilvie-Harris scoring system was used as a clinical scale to evaluate pain, swelling, stiffness and limitation of activity. The results were scored as excellent (15 to 16 points), good (13 to 14) and otherwise unsatisfactory. The time to return to full activity including sports activity was determined. Results: Eighteen of twenty one patients had an excellent outcome. Three patients were graded unsatisfactory and two of them abandoned their career due to the persistence of residual pain. Concomitant abnormalities were found including twelve cases of chronic ankle instability, three cases of osteochondral lesion and two cases of flexor hallucis longus tendinitis. Conclusion: Open debridement was successfully applied to the elite level soccer player with anterior impingement syndrome of the ankle. Considerable coexistence of other abnormalities such as chronic ankle instability may encourage us to consider additional operative procedure.

• Journal of Veterinary Clinics
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• v.33 no.2
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• pp.135-137
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• 2016

A 6-month-old, weighing 2.8 kg, female, domestic short-haired cat presented with open fracture at right distal radius about a month ago. Based on radiological findings, hyperplasia at the right radioulna and left humerus was found. Results of the cytological examination were inflammatory reaction and reactive osteoblast. Distal radial ostectomy proceeded with necrotic bone debridement. Three weeks after operation, the radial bone lysis was seen on radiograph but clinical condition improved. Hyperplasia at the right radioulna and left humerus was dissolved. Two months after operation, she can use her both forelimbs despite right elbow have been diagnosed as arthrosclerosis because of periosteal reaction. Six months after operation, clinical symptoms of limbs were not detected. In this case, open fracture was treated through delayed surgical debridement procedure, therefore hematogenous osteomyelitis occurs at another forelimb. The longer a wound remains open, the more likely it is that infection will develop. The infection can occur to fracture bone and seed from hematogenous spread to another normal bone. In conclusion, when open fracture occurs, early antibiotic treatment and urgent surgical intervention are recommended.

• Archives of Plastic Surgery
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• v.47 no.3
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• pp.228-234
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• 2020

Background A patient's overall condition sometimes does not allow for the complete removal of a dead eschar or injured slough in cases involving a pressure-injury skin lesion. This frequently occurs in clinical practice, particularly in bedridden and older patients receiving home care or intensive care. Even after debridement, it is also difficult to manage open exudative wounds in these patients. Nevertheless, when a mature or immature eschar is treated without proper debridement, liquefaction necrosis underneath the eschar or slough tends to reveal a large, open wound with infectious exudates. We hypothesized that if the presence of any bacteria under the eschar can be evaluated and the progression of the presumed infection of the subeschar can be halted or delayed without creating an open wound, the final wound can be small, shallow, and uninfected. Methods Using a punch instrument, we performed 34 viable subeschar tissue cultures with a secure junction between the eschar and the normal skin. Results The bacterial study had 29 positive results. Based on these results and the patient's status, appropriate antibiotics could be selected and administered. The use of suitable antibiotics led to relatively shallow and small exposed wounds. Conclusions This procedure could be used to detect potentially pathogenic bacteria hidden under black or yellow eschars. Since subeschar infections are often accompanied by multidrug-resistant bacteria, the early detection of hidden infections and the use of appropriate antibiotics are expected to be helpful to patients.

• Clinics in Shoulder and Elbow
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• v.24 no.3
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• pp.183-188
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• 2021

We report a case of a 69-year-old right-dominant man who had an open Monteggia-like lesion of the right elbow (Gustilo-Andersen IIIA) with severe proximal ulna bone loss associated with an ipsilateral ulnar shaft fracture due to a motorcycle accident. The patient underwent two-stage surgery. Wound debridement and bridging external fixation were performed at first. Three months later, a frozen massive osteochondral ulnar allograft was implanted and fixed with a locking compression plate. A superficial wound infection appeared 5 weeks after the second surgery. Superficial wound debridement, negative pressure therapy, and antibiotics were administered for 3 months, achieving infection healing. At 3 years post-surgery, the elbow range of motion was satisfactory with a Disabilities of the Arm, Shoulder and Hand (DASH) score of 16.7. Radiographs and computed tomography scans showed good allograft-bone integration without allograft reabsorption or hardware loosening. Although not complication-free, massive ulna osteochondral allograft implantation can be considered a valid option in cases of open Monteggia-like lesions associated with ulnar shaft fracture and severe bone loss in active patients, whenever osteosynthesis or joint replacement is not a proper solution. This type of bone stock restoration allows for future surgery, if needed.

• Journal of Korean Foot and Ankle Society
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• v.28 no.1
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• pp.8-14
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• 2024

Purpose: Ankle fracture fixation is the gold standard of treatment but it does have its own complications. There is inadequate data regarding the comparative effectiveness of early vs. delayed fixation for open ankle fracture outcomes. This study compares the clinical and functional outcomes of open ankle fractures treated by early or delayed definitive fixation and identifies the limitations of both methods. Materials and Methods: All 73 patients enrolled in the study underwent surgical intervention within 24 hours of injury. The early fixation group (group A) consisting of 39 patients underwent definitive fixation as an index procedure, while the delayed fixation group (group B) consisted of 34 patients who underwent debridement and external fixator application as an index procedure and definitive fixation when soft tissue condition was conducive. All patients were evaluated at 2, 6, and 12 weeks postoperatively and then three monthly for a year. Results: Enneking and American Orthopaedic Foot and Ankle Society scores were markedly higher in the early fixation group at 6 months postoperatively (p-values <0.001 and 0.011, respectively). However, no discernible intergroup difference was evident at 12 months postoperatively. Between 6 and 12 months, group functional outcome scores were significantly different. At 6 months, there was a substantial difference in dorsiflexion between the two groups (p-values 0.001 and <0.001, respectively), but no difference was observed at 12 months postoperatively. At 6 and 12 months, group average plantar flexions were non-significantly different. Conclusion: Early definitive fixation of complex ankle fractures using a targeted approach produced promising results for lower grade open fractures (grades 1 and 2), and delayed definitive fixation, after initial external fixation to allow for soft tissue stabilization, produced promising results for higher grade open fractures (grades 3A and 3B). At 12-month follow-ups, clinical and functional outcomes achieved using these strategies were equivalent.

• 대한정형외과스포츠의학회:학술대회논문집
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• 2004.09a
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• pp.64-64
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• 2004

• Journal of the Korean Arthroscopy Society
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• v.16 no.1
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• pp.40-46
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• 2012

Purpose: This study evaluated the clinical outcome of arthroscopic debridement of anterior compartment and mini-open resection of posterior osteophyte for the treatment of primary osteoarthritis of the elbow. Materials and Methods: Between March 2003 and Feburary 2010, 19 cases who were performed arthroscopic debridement of anterior compartment and resection of posterior osteophyte through mini-open procedure for refractory osteoarthritis of the elbow were enrolled. Average follow-up period was 19 months. Mean age was 49 years old. Clinical results were evaluated by the scoring system of Andrew-Carson Rating Scale (ACRS) and Mayo Elbow Performance Score (MEPS). Results: In the range of motion, flexion contracture was improved from $28.7^{\circ}$ preoperatively to $17.9^{\circ}$ postoperatively, further flexion was improved from $105.1^{\circ}$ to $121.8^{\circ}$. In the scoring system of MEPS, score was improved from 51.1 points preoperatively to 87.9 points in last follow up, 3 cases had in excellent result, 13 good and 3 fair. According to the scoring system of ACRS, score was improved from 92.9 points to 168.2 points, 3 excellent, 14 good and 2 fair. Except one case, all cases returned to preoperative ordinary daily living activity and their own job. Conclusion: For the treatment of refractory osteoarthritis of the elbow, arthroscopic debridement of the anterior compartment and mini-open resection of posterior osteophyte would be helpful on pain relief and functional recovery of the elbow. But this procedure was required long term follow-up in aspect of recurrence of osteophytes and progress of arthritis of the elbow.

• Clinics in Shoulder and Elbow
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• v.27 no.1
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• pp.3-10
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• 2024

Background: Gunshot-related fractures near the elbow are challenging, and available data to guide the practitioner are lacking. This report analyzes injury patterns and treatment strategies in a case series from a high-volume urban trauma center. Methods: All periarticular gunshot fractures near the elbow treated at a level 1 trauma center from 2014 to 2018 were retrospectively reviewed. Fracture location, patient demographics, concomitant injuries, treatment modalities, and complications were analyzed. Results: Twenty-four patients were identified. All patients received prophylactic antibiotics upon admission and underwent urgent surgical debridement. Open reduction and internal fixation (ORIF) was performed with initial debridement in 22 of 24 patients. Seven patients sustained distal humerus fractures, 10 patients sustained isolated proximal ulna or proximal radius fractures, and seven had combined fracture patterns. Eleven patients presented with nerve palsy, and two had transected nerves. Two patients had vascular injury requiring repair. One patient required a temporary elbow-spanning external fixator and underwent staged debridement followed by ORIF. One patient with a grade IIIC fracture developed a deep infection that precluded ORIF. One patient required revision ORIF due to fracture displacement. Conclusions: This investigation reports on management of ballistic fractures near the elbow at a busy urban level I trauma center. Our management centered on rapid debridement, early definitive fixation, and intravenous antibiotic administration. We report on associated neurovascular injury, bone loss, and other challenges in this patient population. Level of evidence: IV.