Effect of endoscopic loop ties in acute appendicitis on wound infection rate: A meta-analysis

A meta-analysis study to measure the consequence of endoscopic loop ties (ELT) in acute appendicitis (AA) on wound infection rate. A comprehensive literature inspection till February 2023 was applied and 2765 interrelated studies were reviewed. The 27 chosen studies enclosed 15 093 subjects with AA in the chosen studies' starting point, 7141 of them were ELT, and 7952 were open surgery. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the effect of ELT in AA on wound infection rate by the dichotomous and continuous styles and a fixed or random model. Open surgery had a significantly higher postoperative surgical site wound infection (SSWI). (OR, 1.41; 95% CI, 1.09–1.83, P = 0.009) with low heterogeneity (I² = 34%) compared to ELT in AA subjects. Although no significant difference was detected between open surgery and ELT in intra-abdominal abscess rate (OR, 0.88; 95% CI, 0.56–1.40, P = 0.59) with moderate heterogeneity (I² = 51%) in AA subjects. Open surgery had a significantly higher postoperative SSWI, however, no significant difference was found in intra-abdominal abscess rate compared to ELT in AA subjects. However, caused by the small sample sizes of several chosen studies for this meta-analysis, care must be exercised when dealing with its values.     

骨折内固定术后伤口感染的诊治

2012年1月~2018年12月,我科诊治36例骨折内固定术后伤口感染患者,取得良好效果,报道如下。1材料与方法1.1病例资料本组36例,男31例,女5例,年龄17~76岁。感染发生于术后26 d^10个月,感染病程2 d^4个月。原手术切口或其周围皮肤、皮下软组织坏死感染27例,合并钢板或骨外露5例,窦道形成、骨膜反应、骨质坏死4例。     

Effect of silver on burn wound infection control and healing: review of the literature

Silver compounds have been exploited for their medicinal properties for centuries. At present, silver is reemerging as a viable treatment option for infections encountered in burns, open wounds, and chronic ulcers. The gold standard in topical burn treatment is silver sulfadiazine (Ag-SD), a useful antibacterial agent for burn wound treatment. Recent findings, however, indicate that the compound delays the wound-healing process and that silver may have serious cytotoxic activity on various host cells. The present review aims at examining all available evidence about effects, often contradictory, of silver on wound infection control and on wound healing trying to determine the practical therapeutic balance between antimicrobial activity and cellular toxicity. The ultimate goal remains the choice of a product with a superior profile of infection control over host cell cytotoxicity.     

Effect of laparoscopic pancreaticoduodenectomy on the incidence of surgical-site wound infection: A meta-analysis

A meta-analysis was conducted to assess the impact of robotic and laparoscopic pancreaticoduodenectomies on postoperative surgical site wound infections. A comprehensive computerised search of databases, such as PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang Data, was performed to identify studies comparing robotic pancreaticoduodenectomy (PD) with laparoscopicPD. Relevant studies were searched from the inception of the database construction until April 2023. The meta-analysis outcomes were analysed using odds ratios (OR) with corresponding 95% confidence intervals (CI). The RevMan 5.4 software was used for the meta-analysis. The findings of the meta-analysis showed that patients who underwent laparoscopic PD had a significantly lower incidence of surgical-site wound (16.52% vs. 18.92%, OR: 0.78, 95% CI: 0.68–0.90, P = .0005), superficial wound (3.65% vs. 7.57%, OR: 0.51, 95% CI: 0.39–0.68, P < .001), and deep wound infections (1.09% vs. 2.23%, OR: 0.53, 95% CI: 0.34–0.85, P = .008) than those who received robotic PD. However, because of variations in sample size between studies, some studies suffered from methodological quality deficiencies. Therefore, further validation of this result is needed in future studies with higher quality and larger sample sizes.     

The effect of time to theatre on infection rate for open tibia fractures

BACKGROUND: Open tibia fractures are an orthopaedic emergency. Surgical intervention has traditionally been recommended within 6 h of injury to decrease the risk of infection. There is little support for this time frame in published works, with no prospective randomized controlled trials to date. We sought to determine whether delay to definitive treatment affected the infection rate in open fractures of the tibia at our institution. METHODS: A retrospective review of 161 consecutive skeletally mature patients with open tibia fractures treated at Liverpool Hospital was carried out. Cases were reviewed using the department database and the medical records. Time between injury and surgery was recorded as 0-6, 6-12 or 12-24 h. The infection rate was calculated for each group, and statistical significance was calculated using the chi(2)-test. RESULTS: No increase in the infection rate was found with increasing time to theatre, as five of the six infections occurred in the 0 to 6-h group, and no infection occurred when treatment was delayed by more than 12 h. The infection rate was found to correlate with the grade of the open injury. CONCLUSIONS: The infection rate after open tibia fractures is strongly associated with the grade of the open fracture rather than the time to initial surgery. It may be justified to delay surgery on open tibia fractures until an optimal operating environment can be provided.     

Effect of prophylactic central neck dissection following total thyroidectomy on surgical site wound infection,hematoma, and haemorrhage in subjects with clinically node-negative papillary thyroid carcinoma: A meta-analysis

We performed a meta-analysis to evaluate the effect of prophylactic central neck dissection following total thyroidectomy on surgical site wound infection, hematoma, and haemorrhage in subjects with clinically node-negative papillary thyroid carcinoma. A systematic literature search up to April 2022 was performed and 3517 subjects with clinically node-negative papillary thyroid carcinoma at the baseline of the studies; 1503 of them were treated with prophylactic central neck dissection following total thyroidectomy, and 2014 were using total thyroidectomy. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated to assess the effect of prophylactic central neck dissection following total thyroidectomy on surgical site wound infection, hematoma, and haemorrhage in subjects with clinically node-negative papillary thyroid carcinoma using the dichotomous method with a random or fixed-effect model. The prophylactic central neck dissection following total thyroidectomy subjects had a significantly lower surgical site wound infection (OR, 0.40; 95% CI, 0.20–0.78, P = .007) in subjects with clinically node-negative papillary thyroid carcinoma compared with total thyroidectomy. However, prophylactic central neck dissection following total thyroidectomy did not show any significant difference in hematoma (OR, 0.08; 95% CI, 0.43–2.71, P = .87), and haemorrhage (OR, 0.72; 95% CI, 0.26–1.97, P = .52) compared with total thyroidectomy in subjects with clinically node-negative papillary thyroid carcinoma. The prophylactic central neck dissection following total thyroidectomy subjects had a significantly higher surgical site wound infection, and no significant difference in hematoma, and haemorrhage compared with total thyroidectomy in subjects with clinically node-negative papillary thyroid carcinoma. The analysis of outcomes should be with caution because of the low number of studies in certain comparisons.     

Incidence rate and risk factors of surgical wound infection in general surgery patients: A cross-sectional study

Hospital-acquired infections (HAIs) are considered a major challenge in health care systems. One of the main HAIs, playing an important role in increased morbidity and mortality, is surgical wound infection. Therefore, this study aimed to determine the incidence rate and risk factors of surgical wound infection in general surgery patients. This cross-sectional study was performed on 506 patients undergoing general surgery at Razi hospital in Rasht from 2019 to 2020. Bacterial isolates, antibiotic susceptibility pattern, antibiotic administration, and its type, operation duration and shift, the urgency of surgery, people involved in changing dressings, length of hospitalisation, and levels of haemoglobin, albumin, and white blood cells after surgery were assessed. The frequency of surgical wound infection and its association with patient characteristics and laboratory results were evaluated. The SPSS software package (version 16.0, SPSS Inc., Chicago, IL, USA) was used to analyse the data. Quantitative and qualitative variables were presented using mean (standard deviation) and number (percentage). The Shapiro–Wilk test was used to evaluate the normality of the data in this study. The data did not have a normal distribution. Hence, χ² and Fisher's exact tests were used to evaluate the relationship between variables. Surgical wound infection occurred in 4.7% (24 cases) of patients with a mean age of 59.34 (SD = 14.61) years. Preoperative (>3 days) and postoperative (>7 days) hospitalisation, history of immunodeficiency (P < 0.001), and interns responsible for changing dressings (P = 0.021) were associated with surgical wound infection incidence. About 9.5% and 4.4% of surgical wound infection cases were significantly associated with pre- and postoperative antibiotic use. Gram-positive cocci were the most prevalent strains isolated from 24 surgical wound infection cases (15/24, 62.5%). Among these, Staphylococcus aureus was the predominant species, followed by coagulase-negative staphylococci. In addition, the most common Gram-negative isolates identified were Escherichia coli bacteria. Overall, administration of antibiotics, emergency surgery, surgery duration, and levels of white blood cells and creatinine were identified as surgical wound infection-associated risk factors. Identifying important risk factors could help control or prevent surgical wound infections.     

冲洗液量对预防开放骨折创面感染的细菌学研究

目的检测不同剂量冲洗液处理开放骨折创面后的细菌数,探讨伤口最佳冲洗液量。方法选择30例GustilloⅢ型开放骨折患者,冲洗前立刻进行创面细菌培养。分别在创面冲洗量达到1、2、3.5、4.5 L时采集伤口内组织,进行细菌学监测。结果冲洗1L时细菌的残留数较冲洗前明显减少(P0.01);冲洗1 L时和2 L时的细菌数差异无统计学意义(P0.05);冲洗3.5 L时较冲洗2 L时残留细菌数明显减少(P0.05);冲洗3.5L时与冲洗4.5 L时细菌数差异无统计学意义(P0.05)。结论 GustilloⅢ型开放骨折的冲洗液量在3.5 L左右时,既能达到了良好的冲洗效果,又能减少了冲洗带来的不良反应。     

Effect of serologic malnutrition on postoperative wound infection problems after total joint arthroplasty: A meta-analysis

We performed a meta-analysis to evaluate the effect of serologic malnutrition on postoperative wound infection problems after total joint arthroplasty. A systematic literature search up to April 2022, was performed and 446 501 subjects with total joint arthroplasty at the baseline of the studies; 200 433 of them were confirmed serologic malnutrition, and 246 068 were confirmed normal nutrition. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated to assess the effect of serologic malnutrition on postoperative wound infection problems after total joint arthroplasty using the dichotomous method with a random or fixed-effect model. The serologic malnutrition subjects had a significantly higher wound disruption (OR, 1.97; 95% CI, 1.53–2.53, P < 0.001), higher superficial incisional surgical site infection (OR, 2.89; 95% CI, 1.67–5.01, P < 0.001), higher deep incisional surgical site infection (OR, 3.06; 95% CI, 2.36–3.96, P < 0.001), and higher organ space surgical site infection (OR, 3.15; 95% CI, 2.34–4.24, P < 0.001) in subjects after total joint arthroplasty compared with normal nutrition. The serologic malnutrition subjects had a significantly higher wound disruption, superficial incisional surgical site infection, deep incisional surgical site infection, and organ space surgical site infection in subjects after total joint arthroplasty compared with normal nutrition. The analysis of outcomes should be with caution because of the low number of studies in certain comparisons.     

Unexpectedly increased rate of surgical site infections following implant surgery for hip fractures: problem solution with the bundle approach

Introduction

Surgical site infections (SSIs) are the most common nosocomial infections after surgery. However, clinical guidance on how to handle any suspicious clusters of SSI in orthopaedic surgery is missing. We report on problem analysis and solution finding following the observation of an increased rate of SSI in trauma implant surgery.

Setting

Trauma unit of a university hospital.

Methods

Over a 2-year observation period, all patients (n = 370) following surgical stabilisation of proximal femur fractures in a trauma unit of a university hospital were consecutively followed using a standardised case report form. First, a retrospective cohort of 217 patients was collected for whom an increased SSI rate was detected. Based on risk analysis, new standard perioperative procedures were developed and implemented. The impact was evaluated in a prospective cohort of 153 comparable patients. Uni- and multivariable analysis of factors associated with the risk for SSI was undertaken.

Results

The intervention bundle resulted in a significant reduction of an initially increased SSI incidence of 6.9 (down) to 2.0% (p = 0.029). Multivariable analysis revealed four risk factors significantly associated with a higher risk of SSI caused by different bacteria: duration of surgery (p = 0.002), hemiarthroplasty (p = 0.002), haematoma (p = 0.004) and the presence of two operating room staff members (p < 0.001 and 0.035).

Conclusions

A standardised prospective SSI protocol and detection system offering the simultaneous use of data should guarantee every institution immediate alarm registration to avoid comparable problem situations. Detailed interdisciplinary analysis followed by the implementation of coherent interventions, based on a best-evidence structured bundle approach, may adequately resolve similar critical incidence episodes.     

Mechanisms,prediction, and prevention of ACL injuries: Cut risk with three sharpened and validated tools

Economic and societal pressures influence modern medical practice to develop and implement prevention strategies. Anterior cruciate ligament (ACL) injury devastates the knee joint leading to short term disability and long term sequelae. Due to the high risk of long term osteoarthritis in all treatment populations following ACL injury, prevention is the only effective intervention for this life‐altering disruption in knee health. The “Sequence of Prevention” Model provides a framework to monitor progress towards the ultimate goal of preventing ACL injuries. Utilizing this model, our multidisciplinary collaborative research team has spent the last decade working to delineate injury mechanisms, identify injury risk factors, predict which athletes are at‐risk for injury, and develop ACL injury prevention programs. Within this model of injury prevention, modifiable factors (biomechanical and neuromuscular) related to injury mechanisms likely provide the best opportunity for intervention strategies aimed to decrease the risk of ACL injury, particularly in female athletes. Knowledge advancements have led to the development of potential solutions that allow athletes to compete with lowered risk of ACL injury. Design and integration of personalized clinical assessment tools and targeted prevention strategies for athletes at high risk for ACL injury may transform current prevention practices and ultimately significantly reduce ACL injury incidence. This 2016 OREF Clinical Research Award focuses on the authors’ work and contributions to the field. The author's acknowledge the many research groups who have contributed to the current state of knowledge in the fields of ACL injury mechanisms, injury risk screening and injury prevention strategies. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1843–1855, 2016.     

Effect of serologic malnutrition on postoperative wound infection problems after total joint arthroplasty: A meta‐analysis

We performed a meta‐analysis to evaluate the effect of serologic malnutrition on postoperative wound infection problems after total joint arthroplasty. A systematic literature search up to April 2022, was performed and 446 501 subjects with total joint arthroplasty at the baseline of the studies; 200 433 of them were confirmed serologic malnutrition, and 246 068 were confirmed normal nutrition. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated to assess the effect of serologic malnutrition on postoperative wound infection problems after total joint arthroplasty using the dichotomous method with a random or fixed‐effect model. The serologic malnutrition subjects had a significantly higher wound disruption (OR, 1.97; 95% CI, 1.53–2.53, P < 0.001), higher superficial incisional surgical site infection (OR, 2.89; 95% CI, 1.67–5.01, P < 0.001), higher deep incisional surgical site infection (OR, 3.06; 95% CI, 2.36–3.96, P < 0.001), and higher organ space surgical site infection (OR, 3.15; 95% CI, 2.34–4.24, P < 0.001) in subjects after total joint arthroplasty compared with normal nutrition. The serologic malnutrition subjects had a significantly higher wound disruption, superficial incisional surgical site infection, deep incisional surgical site infection, and organ space surgical site infection in subjects after total joint arthroplasty compared with normal nutrition. The analysis of outcomes should be with caution because of the low number of studies in certain comparisons.     

Effect of single-port video-assisted thoracoscopy on surgical site wound infection and healing in patients with lung cancer: A meta-analysis

We performed a meta-analysis to comprehensively assess the effect of single-port video-assisted thoracoscopy on surgical site wound infection and healing in patients with lung cancer. A computerised search for studies on single-port video-assisted thoracoscopy treatment of lung cancer was conducted from the time of database creation through February 2023 using the PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases. Two investigators independently screened the literature, extracted information, and evaluated the quality of studies according to inclusion and exclusion criteria. Either a fixed or random-effects model was used in calculating the relative risk (RR) with 95% confidence intervals (CIs). Meta-analysis was performed using RevMan 5.4 software. The results showed that, compared with multi-port video-assisted thoracoscopy, single-port video-assisted thoracoscopy significantly reduced surgical site wound infection (RR: 0.38, 95% CI: 0.19–0.77, P = .007) and significantly promoted wound healing (RR: 0.37, 95% CI: 0.22–0.64, P < .001). Compared with multi-port video-assisted thoracoscopy, single-port video-assisted thoracoscopy significantly reduced surgical site wound infections and also promoted wound healing. However, because of large variations in study sample sizes, some of the literature reported methods of inferior quality. Additional high-quality studies containing large sample sizes are needed to further validate these results.     

Effect of wound protectors in reducing the incidence of surgical site wound infection in lower gastrointestinal surgery: A meta-analysis

We performed a meta-analysis to evaluate the effect of wound protectors in reducing the incidence of surgical site wound infection in lower gastrointestinal surgery. A systematic literature search up to June 2022 was performed and 6026 subjects with lower gastrointestinal surgery at the baseline of the studies; 3090 of them were using the wound protector, and 2936 were using no wound protector. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated to assess the effect of wound protectors in reducing the incidence of surgical site wound infection in lower gastrointestinal surgery using the dichotomous methods with a random or fixed-effect model. The surgical site wound infection was significantly lower with single-ring wound protectors (OR, 0.53; 95% CI, 0.39-0.83, P = .004), and dual-ring wound protectors (OR, 0.44; 95% CI, 0.35-0.56, P < .001) in subjects with lower gastrointestinal surgery compared with no wound protector. The surgical site wound infection was significantly lower with single-ring wound protectors, and dual-ring wound protectors in subjects with lower gastrointestinal surgery compared with no wound protector. The analysis of outcomes should be with caution because of the low sample size of 5 out of 28 studies in the meta-analysis and a low number of studies in certain comparisons.     

负压封闭引流加外固定架治疗胫腓骨开放性骨折感染创面

目的探讨持续负压封闭引流（VSD）加外固定架治疗胫腓骨开放性骨折感染创面的临床疗效。方法对32例严重的胫腓骨开放性骨折伴大面积伤口感染患者,清创后VSD敷料覆盖创面,应用VSD技术5～7 d,待肉芽生长、创面新鲜后行中厚皮片植皮治疗。结果 32例VSD治疗1周后去除VSD敷料,伤口感染控制,局部创面肉芽组织新鲜,愈合良好。结论 VSD可以改善局部微循环,促进肉芽组织生长及有效地避免交叉感染,促进大面积皮肤缺损感染伤口的愈合,为二次植皮提供条件。     

Effect of prophylactic central neck dissection following total thyroidectomy on surgical site wound infection,hematoma, and haemorrhage in subjects with clinically node‐negative papillary thyroid carcinoma: A meta‐analysis

We performed a meta‐analysis to evaluate the effect of prophylactic central neck dissection following total thyroidectomy on surgical site wound infection, hematoma, and haemorrhage in subjects with clinically node‐negative papillary thyroid carcinoma. A systematic literature search up to April 2022 was performed and 3517 subjects with clinically node‐negative papillary thyroid carcinoma at the baseline of the studies; 1503 of them were treated with prophylactic central neck dissection following total thyroidectomy, and 2014 were using total thyroidectomy. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated to assess the effect of prophylactic central neck dissection following total thyroidectomy on surgical site wound infection, hematoma, and haemorrhage in subjects with clinically node‐negative papillary thyroid carcinoma using the dichotomous method with a random or fixed‐effect model. The prophylactic central neck dissection following total thyroidectomy subjects had a significantly lower surgical site wound infection (OR, 0.40; 95% CI, 0.20–0.78, P = .007) in subjects with clinically node‐negative papillary thyroid carcinoma compared with total thyroidectomy. However, prophylactic central neck dissection following total thyroidectomy did not show any significant difference in hematoma (OR, 0.08; 95% CI, 0.43–2.71, P = .87), and haemorrhage (OR, 0.72; 95% CI, 0.26–1.97, P = .52) compared with total thyroidectomy in subjects with clinically node‐negative papillary thyroid carcinoma. The prophylactic central neck dissection following total thyroidectomy subjects had a significantly higher surgical site wound infection, and no significant difference in hematoma, and haemorrhage compared with total thyroidectomy in subjects with clinically node‐negative papillary thyroid carcinoma. The analysis of outcomes should be with caution because of the low number of studies in certain comparisons.     

Effects of negative pressure wound therapy on wound infection and healing in patients with open fracture wounds: A meta-analysis

A meta-analysis was conducted to comprehensively evaluate the impact of negative pressure wound therapy (NPWT) on wound infection and healing in patients with open fracture wounds. Computer searches were performed in EMBASE, Google Scholar, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure databases for randomized controlled trials (RCTs) on the application of NPWT in open fracture wounds, with the search period covering the databases inception to September 2023. Two researchers independently screened the literature, extracted data and conducted quality assessments. Stata 17.0 software was employed for data analysis. Overall, 17 RCTs involving 1814 patients with open fracture wounds were included. The analysis revealed that compared with other treatment methods, NPWT significantly shortened the wound healing time (standardized mean difference [SMD] = −2.86, 95% confidence intervals [CI]: −3.51 to −2.20, p < 0.001) and fracture healing time (SMD = −3.14, 95% CI: −4.49 to −1.79, p < 0.001) in patients with open fracture wounds. It also significantly reduced the incidence of wound infection (odds ratio [OR] = 0.36, 95% CI: 0.23–0.56, p < 0.001) and complications (OR = 0.29, 95% CI: 0.20–0.40, p < 0.001). This study indicates that in the treatment of open fracture wounds, NPWT, compared with conventional treatment methods, can accelerate the healing of wounds and fractures, effectively control infections and reduce the occurrence of complications, demonstrating high safety.     

Comparison of laparoscopic and open appendectomy on wound infection and healing in complicated appendicitis

The aim of this study was to investigate the effects of laparoscopic and open surgery on the development of postoperative surgical wound infection and wound healing between complicated appendicitis patients. Patients with complicated appendicitis were divided into those underwent laparoscopic and open surgical procedures according to the surgical method. Patients were followed up with regard to development of any postoperative wound infection, and medical, radiological, and surgical treatment methods and results were recorded. A total of 363 patients who underwent appendectomy were examined, of which 103 (28.4%) had complicated appendicitis. Postoperative wound infection rate in patients who underwent open surgery was 15.9%, while it was 6.8% in the laparoscopic surgery group. There was no statistically significant difference between the two groups in terms of infection development rates (P > .05). The rate of surgical drainage use and rehospitalisation was significantly higher in the group with wound infection than in the group without wound infection. (P < .05). We suggest that in terms of wound infection and wound healing, laparoscopic surgery should be the method of choice for patients with complicated appendicitis. In order to reduce the frequency of wound infection, drains should not be kept for a long time in patients undergoing appendectomy.     

The microbiology and risk of infection following open, agricultural upper extremity injuries

PURPOSE: This study was designed to determine the microbiology and risk of infection following open, agricultural, upper extremity injuries. Specifically, we sought to evaluate the microbiology of the wounds at the time of initial treatment and the development of any subsequent infections, determine whether the development of subsequent infection was related to injury severity, and clarify whether the microorganisms isolated at the time of initial treatment and development of subsequent infection were susceptible to the initial antibiotic prophylaxis. METHODS: A retrospective chart review of 214 patients was conducted. RESULTS: The initial injuries were classified into 1 of 3 groups, with 1 being the least severe and 3 being the most severe. Twenty-six were type 1 injuries, 94 type 2, and 94 type 3 injuries. Forty patients developed infection following the injury. Seventeen had superficial wound infection, 16 had deep soft tissue infections, and 7 developed osteomyelitis. Six went on to an amputation due to infection. Fifteen of the infections were polymicrobial. The number of patients who developed infection in the first 6 months following injury was 2, 14, and 24 for type 1, 2, and 3 injuries respectively (p=.07). CONCLUSIONS: Empiric antimicrobial regimens for the management of infection requiring surgical debridement following open upper extremity agricultural injury should be active against staphylococci, aerobic gram-negative bacilli, and anaerobes, but not necessarily against fungi. These antibiotics ideally should be administered on initial presentation of the patient to the emergency department. Prospective studies with emphasis on timely acquisition of cultures and sensitivities are needed to determine optimal prophylactic antimicrobial therapy for these injuries and directed antibiotic regimens for the infections that may develop. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.