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Sun Apr 16 13:19:26 BST 2006

I believe I've gotten a similar impression from the discussion. In cases where there is a low likelihood of potentially-contaminating structure ruptures, standard irrigating procedures apply. In cases where there is a higher likelihood of the aforementioned event, such as in large or spread projectile wounds, crush trauma, or difficult impalement, a careful prophylactic dose of ABs is a rather safe option that minimizes perioperative infection, although we're not aware of any in vitro studies that prove the ABs make a particularly tremendous difference in specifically preventing severe sepsis.

  -Mike F

Krin135 at aol.com wrote:

In a message dated 15-Apr-06 12:12:19 Central Daylight Time, ben
sonblues at comcast.net writes:

Dr. Ricky, 
It is you not getting it. The discussion was about a patient with an 
acetabular fracture, remember? We operate on that here in Detroit. Oh, yes, and they 
get prophylactic antiobiotics. What a babbling fool. You need to take your 
lithium, buddy.
DB

I'm taking the liberty of compiling the responses from Claudia and the 
others into an article that I intend to submit to Karim for inclusion in the 
Trauma Wiki. While I'm waiting to get the full text of several articles that I 
intend to use as reference, I believe that I can sum up what both a bit of 
MedLine research and several members of this august group have tried to explain...

In pelvic trauma, IF there is NO skin breach AND NO internal organ damage 
(i.e., a pure acetabular fracture) AND appropriate debriedment of any 
devitalized tissue is carried out (including but not limited to a thorough irrigation 
prior to closure), THEN there is no need for antibiotics as 'prophylaxis'. 
Appropriate intraoperative and blood cultures should be carried out, and the 
wound watched for infection, just as if it were an elective hip replacement.

IF there is a contaminating skin breach OR internal organ damage, the first 
priority is to accomplish a mechanical toilet via appropriate and complete 
debriedment and lavage, with anatomical closure or a diverting stoma as needed. 
Consideration of prophylatic antibiotics (ranging from one intraoperative 
dose to a short (less than 5 day) course of antibiotics MAY be of some help in 
this case, based on studies done involving 'elective' colorectal and gyn 
surgery.

Hope I am understanding and explaining the situation a bit better.

ck

Charles S. Krin, DO FAAFP

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Prophylactic antibiotics