Radical Debridement? No, Aggressive Radical Debridement for High-Energy Open War Trauma to Limbs

Radical surgical debridement is the main component of treatment after high-energy open fractures to limbs, especially after war injury. Its success largely determines the course and result of the treatment. It is often impossible in primary surgery and even in second look procedure to define clear boundaries of critical tissue damage requiring removal. Necrotic tissue remaining in the depth of the wound will lead in the future to serious infectious complications with long-term antimicrobial treatment and additional surgical interventions, chronic deep infection and osteomyelitis, and even amputations in complex cases. On the other hand, excessive surgical excision can lead to significant tissue loss, demand in the consequence of complex plastic tissue transfer.

The unique abilities of distraction tissue genesis by G.A.Ilizarov without needing of massive bone grafting allow to orthopedic surgeon more freedom during primary debridement procedure. Aggressive radical debridement with subsequent replacement of post-traumatic and post-surgical bone defects by method of distractional osteogenesis (after general patient’s and local limb’s stabilization) has been successfully used in treatment of dozens of the victims Syrian civil war. All patients returned home without signs of infection in the early postoperative period, which allows us to recommend aggressive-radical surgical debridement for treatment of high-energy open war trauma to limbs.