Description
In this presentation, Daren Forward from Nottingham discusses the principles and advancements in the surgical technique known as "fix and flap," originally established by Malcolm Smith two decades ago. He highlights the foundational work laid out in Smith's seminal paper that introduced a radical approach to treating open fractures, emphasizing early soft tissue coverage and skeletal stabilization. The results from Smith's initial studies, involving 84 patients, demonstrated a remarkable salvage rate and infection rates around 10%, which have remained consistent over the years.
Forward also reflects on the evolution of treatment strategies, exploring the insights from recent contributions by Mike Kelly, who suggests retaining some devitalized bone fragments under certain conditions to improve patient outcomes. He shares data from clinical experiences, indicating a relationship between tight control over surgical practices and reduced infection rates, particularly emphasizing the necessity for both orthopedic and plastic surgeons to collaborate during primary closures.
Through comparing historical data with contemporary practices, including outcomes from patients treated under various protocols, Forward advocates for high-quality surgical decision-making, which he attributes to significant improvements in patient recovery. He concludes by raising critical points for discussion regarding current consent practices for open treatments and the relative merits of fixation options, prompting considerations for future practices in orthopedic surgery.