Effect of Debridement on Posttraumatic Soft Tissue Coverage in University of Calabar Teaching Hospital, Nigeria

Posttraumatic injuries are a common occurrence in our Accident and Emergency department arising from different mechanisms of injuries. Surgical debridement is routinely done as a part of our management protocol. Surgical debridement is done to reduce or prevent wound infection, decrease flap loss, reduce posttraumatic osteomyelitis as well as decrease hospitalization time and management cost. We aim at highlighting the rate of flap viability and infection in relation to the timing of surgical debridement and wound coverage. A retrospective study with the information gathered from the patient case-notes and Casualty Register. All posttraumatic patients that presented between January 2013 and December 2014 were recruited into the study. The patients were resuscitated and wounds debrided within 48hours of presentation. wounds lasting longer than seven days prior to the presentation were excluded from the study on account of late presentation. wound swabs for microscopy, culture, and sensitivity were done. Out of 342 patients seen in the hospital with 568 posttraumatic injuries, 133patients with 205 open wounds were recruited into the study. The male- female ratio was 131. Superficial soft tissue infection occurred in 12 % of those with immediate debridement group of 0-24 hours post-trauma while 15.2 %in early debridement between day 2 and 7post injury period and deep infection was 8.3 %. We had 3.6 % flap loss in the immediate wound closure group while 1.2 % in early wound coverage. Surgical debridement is an important procedure in the management of acute traumatic wounds. Adequate early wound debridement and commencement of antibiotics are very important to reduce wound infection and improve flap viability. The use of flaps within the first two days of injury is fraught with the complication of flap loss, thus, 3 -21 days after trauma could be a preferable time for early flap cover.