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4Treatment - initial surgery for fracture wound infection

Excise the surface of the exposed tissue to leave clearly viable margins of subcutaneous tissue, fascia and muscle.

Excise the surface of the exposed tissue to leave clearly viable margins of subcutaneous tissue, fascia and muscle. Non-viable bone must also be removed with a high-speed burr (suitably irrigated to cool the tissue), or preferably osteotomes, until bone bleeding is encountered. Small bleeding osseous vessels (“paprika sign”) indicate viable bone.

Copious irrigation with Ringer-lactate solution helps to remove bacteria, bits of dead tissue and blood clot, and improves the surgeon’s ability to examine the wound.