Infección en las fracturas abiertas con cierre primario de la herida respecto al cierre diferido: Revisión de la literatura.

Palabras clave: Trauma, Fractura abierta, Cierre primario de la herida, Cierre diferido de la herida, Infección

Resumen

Introducción: Una de las grandes controversias que existen actualmente dentro de la ortopedia es el manejo que se le debe dar a las fracturas abiertas para prevenir la infección ósea postraumática, ya que no son claras las indicaciones de cuando hacer el cierre primario o el cierre diferido de la herida. Objetivo: Describir el comportamiento de la infección en las fracturas abiertas con cierre primario de la herida. Materiales y métodos: Se realizó una búsqueda sistemática de la literatura a noviembre de 2017 en MEDLINE a través de PubMed, mediante los descriptores en salud MeSh “open fracture infections” y “primary wound closure” combinados con el conector Booleano “And”. Resultados: De acuerdo con la metodología de la declaración PRISMA se incluyeron siete artículos que describieron el comportamiento de la infección en fracturas abiertas manejadas con cierre primario o cierre diferido de la herida. Conclusiones: Se evidencia que no hay un acuerdo universal respecto al cierre de la herida durante el manejo de las fracturas abiertas. Los estudios actuales tienden a apoyar el cierre primario debido a que no hay diferencias estadísticamente significativas sobre la incidencia histórica de infecciones postrauma respecto al cierre diferido. Dado que el uso de antibióticos hace parte del protocolo general, la descisión recae en la experiencia clínica del profesional de la salud. Se sugiere diseñar estudios prospectivos y ensayos clínicos aleatorizados con protocolos clínicos farmacológicos y terapéuticos claramente establecidos.

Abstract:

Background: One of the great controversies that currently exist within orthopedics is the management that should be given to open fractures to prevent post-traumatic bone infection, since the indications of when to make the primary closure or the delayed closure of the wound are not clear. Aim: To describe the behavior of the infection in open fractures with primary wound closure. Materials y methods: A systematic literature search was carried out in November 2017 on MEDLINE through PubMed, using the MeSh health descriptors “open fracture infections” and “primary wound closure” combined with the Boolean connector “And”. Results: In accordance with the methodology of the PRISMA statement, seven articles were included that described the behavior of the infection in open fractures managed with primary closure or delayed wound closure. Conclusions: It´s evident that there is no universal agreement regarding wound closure during the management of open fractures. Current studies tend to support primary closure because there are no statistically significant differences on the historical incidence of post-traumatic infections compared to deferred closure. As the use of antibiotics is part of the general protocol, the decision corresponds to the clinical experience of the healthcare professional. It´s suggested to design prospective studies and randomized clinical trials with clearly established pharmacological and therapeutic clinical protocols.

Key words: SARS-CoV-2, Trauma, open fracture, primary wound closure, delayed wound closure, infection.

Biografía del autor/a

Freddy Moreno, Pontificia Universidad Javeriana Cali
Odontólogo, Magíster en Ciencias Biomédicas, Profesor Departamento de Ciencias Básicas de la Salud Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana Cali
Juan Fernando Angel, Pontificia Universidad Javeriana Cali

Médico

Citas

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Publicado
2020-12-26
Cómo citar
Moreno, F., & Angel, J. (2020). Infección en las fracturas abiertas con cierre primario de la herida respecto al cierre diferido: Revisión de la literatura. Salutem Scientia Spiritus, 6(2), 14-20. Recuperado a partir de https://revistas.javerianacali.edu.co/index.php/salutemscientiaspiritus/article/view/2245