damage control soft management - foreonline.org · • everybody familiar with ex‐fix with...
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Damage Control & Soft Tissue Management
John Chao, MDPeachtree Orthopedics
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Who am I to lecture about DCO?These are my emergencies.
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These are your emergencies.
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DCO
• “Damage Control” was coined by the US Navy – Early temporary fracture stabilization aboard a ship while being able to continue to maintain mission integrity.
• Everybody familiar with ex‐fix with conversion to ORIF pending soft tissue integrity
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DCO
• In foot and ankle, DCO doesn’t play as much a role as long bone/pelvic fractures
• Soft tissue management more important in F&A, as tissues can be very thin
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30 yo M presents 3 days s/p motorcross injury
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Still failed.
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36 yo M who fell off roof
-Waited 3 weeks
-Sinus tarsi approach
Longer wait = increased wound complications with extensile approach?
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Healed incisions without complications
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Pilon• Teachings – Keep incisions 7 cm apart
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Pilon• 83% skin bridge less than 7 cm apart.–Mean bridge was 5.9 cm
• Soft tissue complications occurred in 4 (9%) of 46 fractures. – 2 AL incisions – only wound care. – 1 PL incison – healed after HWR– One patient required subsequent surgical procedures for infection.
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Lisfranc ORIF
• My standard incisions• Almost never have more than 4 cm space
• Have never had a post op wound infection– Except when I did a HWR and patient wanted me to remove some of her keloid and one wound dehisced
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Forefoot
• Not aware of forefoot incision studies, but this is safe for reconstructions
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Acute Achilles Rupture
• One area that soft tissues need to be respected is the soft tissues over the achilles
• Minimal retraction for achilles
• Make a bigger incision, not retract harder on a smaller incision
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Questions?