Dead space within the wound
After the first surgical clearance of an infected fracture wound, it is essential to defer suture closure or other definitive soft-tissue cover. Closure may be considered when final clearance has resulted in resolution of the infection.
Empty space (“dead space”) under tissue flaps, or within bony cavities, within the excised wound allows further accumulation of exudate and is likely to become a reservoir of bacteria. Antibiotic levels will be low in this poorly-perfused accumulation of fluid.