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Soft-Tissue Injuries

Source: www.usaisr.amedd.army.mil
Topic: Soft Tissue
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Sort Desciption: The goal in treatment of soft-tissue wounds is to save lives, ... of the tibia when the tissues retract. The saphenous vein and nerve are retracted anteriorly. ...

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Soft-Tissue Injuries All war wounds are contaminated and should not be closed primarily. The goal in treatment of soft-tissue wounds is to save lives, preserve function, minimize morbidity and prevent infections through early and aggressive surgical wound care far forward on the battlefield. Presurgical Care Prevent infection. Antibiotics: Antibiotics are not a replacement for surgical treatment. Antibiotics are therapeutic, not prophylactic, in war wounds. Give antibiotics for all penetrating wounds as soon as possible. Sterile dressing. Place a sterile field dressing as soon as possible. Leave dressing undisturbed until surgery. A one-look soft-tissue examination may be performed on initial presentation. Infection rate increases with multiple examinations prior to surgery. Initial wound cultures unnecessary. Surgical Wound Management Priorities Life-saving procedures before limb and soft-tissue wound care. Save limbs. Vascular repair. Compartment release. 22.2 Emergency War Surgery Prevent infection. Wound surgery within 6 hours of wounding. Antibiotics. Sterile dressing. Fracture immobilization. Superficial penetrating fragment (single or multiple) injuries usually do not require surgical exploration. Simply cleanse the wounds with antiseptic and scrub brush. Nonetheless, depending on location and clinical presentation, maintain high suspicion for vascular injury or intraabdominal penetration. Avoid Swiss cheese surgery (in an attempt to excise all wounds and retrieve fragments). Wound Care Primary Surgical Wound Care Limited longitudinal incisions. Excision of foreign material and devitalized tissue. Irrigation. L EAVE W OUND O PEN N O P RIMARY C LOSURE . Antibiotics and tetanus prophylaxis. Splint for transport (improves pain control). Longitudinal incisions. Wounds are extended with incisions parallel to the long axis of the extremity, to expose the entire deep zone of injury. At the flexion side of ...

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