Ursone listed a number of indications for when to debride a wound containing explosive fragments. The authors if from the San Antonio Orthopaedic Group in San Antonio, Texas.
Patient selection: explosive injury with fragments
Situation
Rationale
wound > 1 cm in diameter
greater risk for necrotic tissue damage and infection
intra-articular fragments
risk for mechanical arthritis, synovitis and lead poisoning
intra-osseous fragments associated with fracture
reduce risk of fracture non-union or to improve fracture fixation
fragments adjacent to a blood vessel
risk of erosion into blood vessel with embolization
An additional indication (not listed by the author) may be an infection unresponsive to conservative management, especially if tissue necrosis or the nature of the fragments is contributing to the infection.
A small wound with small fragments can be managed conservatively with antibiotics. With time the fragment may migrate to the skin surface (“work its way out”) at which time it can be locally excised.
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