Optimizing Surgical Debridement Following High-Energy, Open Trauma with Dynamic, Contrast-Enhanced Fluorescence imaging
Abstract
Injuries to the arms and legs sustained in battle commonly involve broken bones with open wounds (open fracture). Improvements in body armor and rescue strategies have increased the number of survivors of combat-related injuries. An unintended consequence of improved survival is an increase in the severity and complexity of the injuries that must be managed following immediate first aid. High-energy open fractures are associated with severe contamination and disruption in blood flow to the injured bone and soft tissue. Disrupted blood flow (or perfusion) to bone and soft tissue has profound negative consequences, including preventing delivery of antibiotics and the body’s own defenses or immune cells, as well as building blocks for healing, to the injured bone and soft tissue. This is thought to be an important cause for complications and infections after open fracture. Because of this management of open fractures and wound infection is based on aggressive, thorough debridement (or surgical removal) of bone and soft tissue stripped of blood flow. However, currently, there are no methods to measure bone/tissue perfusion during surgery leading to substantial variation in quantity of bone and soft tissue debrided. This places patients at unnecessary risk of complication. This proposal is the next step toward developing a method to guide surgical debridement that will minimize complications and accelerate the time until definitive (or final) management of fractures and overlying soft tissues. This will be a prospective observational study examining the association between bone and tissue perfusion, measured in the operating room using novel optical imaging techniques, and complication in patients who sustain open fracture. 180 Patients with open fracture will be recruited into the study through two level 1 trauma centers, The Dartmouth Hitchcock Medical Center and The R. Adams Cowley Shock Trauma Center. This study will have a substantial military benefit and clinical impact on the care and outcome after high-energy open fractures. Complications such as infection are very common and very serious and are closely associated with high-energy military fractures. These complications delays (and often obliterates) Service members’ ability to return to active duty. Critical to regaining normal lifestyles and returning to active duty is having a highly functional limb, which is predicated on minimizing complications. This study will fill a critical gap in our knowledge base, will serve as preparation for a large clinical trial, and will develop customized software and portable, deployable hardware optimized for real-time intraoperative bone/tissue perfusion data analysis in austere environments.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 10, 2021
- Source ID
- W81XWH2010319
Entities
People
- Ida Leah Gitajn
Organizations
- Dartmouth–Hitchcock Medical Center
- United States Army