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© 2015 John Wiley & Sons, Ltd. All rights reserved. Severe open fractures are best managed jointly by plastic and orthopaedic surgeons from the outset. Following a thorough clinical examination the wound is debrided and the skeleton stabilized. Internal fixation is only performed prior to definitive soft tissue reconstruction. Negative-pressure wound therapy is used as a temporary dressing until vascularized soft tissue reconstruction is undertaken. A devascularized limb requires immediate surgical exploration. The use of vascular shunts will dramatically reduce ischemic time. Compartment syndrome can occur in open fractures and all four compartments should be decompressed and debrided. Early primary amputation may be the best reconstructive option for patients with severe injuries.

Original publication





Book title

Plastic and Reconstructive Surgery: Approaches and Techniques

Publication Date



607 - 627