Vol. 1, Issue 3 (2012)

Author(s):
Kunjam V.V. Satyanarayana Dora1 and V. Mallikarjun Rao

Abstract:
Background: Surgical site infections (SSIs) in open
fractures contribute substantially to patient morbidity, prolonged
hospitalization, and delayed functional recovery. Timely debridement and
soft-tissue reconstruction have been advocated to mitigate infection risk, yet
real-world evidence remains limited. This prospective study investigates the
effect of early surgical intervention on SSI incidence and related outcomes.
Materialsand Methods: A prospective observational study was conducted at the Department
of General Surgery, Sree Balaji Medical College and Hospital, Chennai, from
January to December 2011. Adults aged 18-65 years with Gustilo-Anderson grade
II to IIIB open fractures were included. Early debridement was defined as
intervention within 6 hours of injury, and early flap coverage as within 7 days
of debridement. Outcomes included SSI incidence, osteomyelitis, and hospital
stay duration. Statistical analyses included chi-square tests, t-tests, and
multivariate logistic regression.
Results: Of 350 patients, early debridement
significantly reduced SSI incidence (11.4% vs. 21.8%, p = 0.003), as did early
flap coverage (9.5% vs. 23.2%, p<0.001). Osteomyelitis was less
frequent with early flap coverage (5 vs. 10 cases), and mean hospital stay was
shorter (23.4 vs. 38.6 days, p<0.001). Multivariate analysis showed
that early debridement (OR 0.45, 95% CI: 0.25-0.80) and early flap coverage (OR
0.34, 95% CI: 0.20-0.58) independently reduced SSI risk.
Conclusion: Prompt debridement and early soft-tissue reconstruction are critical in
lowering infection rates and improving outcomes in open fractures. Structured,
time-sensitive surgical protocols should be prioritized in trauma care systems.