REVIEW ARTICLE Prevention of Infections Associated With Combat-Related Extremity Injuries

Abstract: During combat operations, extremities continue to be the most common sites of injury with associated high rates of infectious complications. Overall,15 % of patients with extremity injuries develop osteomyelitis, and17% of those infections relapse or recur. The bacteria infecting these wounds have included multidrug-resistant bacteria such as Acinetobacter baumannii, Pseudomonas aeruginosa, extended-spectrum -lactamase-producing Kleb-siella species and Escherichia coli, and methicillin-resistant Staphylococcus aureus. The goals of extremity injury care are to prevent infection, promote fracture healing, and restore function. In this review, we use a systematic assessment of military and civilian extremity trauma data to provide evi-dence-based recommendations for the varying management strategies to care for combat-related extremity injuries to decrease infection rates. We empha-size postinjury antimicrobial therapy, debridement and irrigation, and surgi-cal wound management including addressing ongoing areas of controversy and needed research. In addition, we address adjuvants that are increasingly being examined, including local antimicrobial therapy, flap closure, oxygen therapy, negative pressure wound therapy, and wound effluent characteriza-tion. This evidence-based medicine review was produced to support th