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Drip! Drip! The Draining Tibial Wound: When it Matters and When it Might Not

Learn when a draining tibial wound is concerning and when it's less worrisome. Understand treatment options and key factors to consider. Includes insights from JD Adams, MD.

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Drip! Drip! The Draining Tibial Wound: When it Matters and When it Might Not

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  1. Drip! Drip! The Draining Tibial Wound: When it Matters and When it Might Not JD Adams, MD Greenville Health System Greenville, SC

  2. Learning Points • What are the most concerning wounds? • How long is too long? • What to do about the draining wound?

  3. When does it matter and when it might not? IT ALWAYS MATTERS!!!

  4. Concerning wounds • Any wound from an open fracture • A surgical incision that has not sealed after 5-7 days • A wound that stopped draining and is now draining again • Continual serous drainage from a surgical site

  5. Specific wounds you cannot “watch” • Medial tibia wounds • Open wound has little between it and the fracture • Wounds with exposed bone or exposed implants

  6. Wounds you can be “less worried” about • Skin necrosis with good granulation bed underneath • No exposed bone or implant • Wound that continues to “granulate” in • What to do? • Wound Vac- Costly but speeds up the process • Consider Skin Graft if large • Wet to Dry dressings • “Prophylactic” Antibiotics???

  7. What about the Wound Vac? • If fracture site exposed NEEDS A FLAP, NOT A WOUND VAC Needs soft tissue coverage

  8. What about the Wound Vac? • If the wound could not be treated with wet to dry dressing, a wound vac is not appropriate

  9. Wound that goes away and then re-emerges • Pay attention to Xrays • Is the fracture healed? • Are the implants loose? May need an infected non-union treatment

  10. Take Home Points • A draining tibia wound ALWAYS matters • A wound vac does not replace a flap • No exposed bone or implant = ok to treat with local wound care • Have a low threshold for soft tissue coverage

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