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Surgery General ec225629

Which one of the following is not a principle followed in the management of missile injuries -

A
Excision of all dead muscles
B
Removal of foreign bodies
C
Removal of fragments of bone
D
Leaving the wound open
High-Yield Explanation
• In limb wounds, exploration is followed by thorough wound excision, after which, with very few exceptions, the wound should be left open. • A minimal amount of skin edge (i.e. only that which has been contaminated) should be excised around the entrance and exit wounds. • Foreign matter should be removed from the wound. • Delayed primary closure should follow within 4-7 days after injury. • Dead muscle that does not bleed or contract, is mushy in consistency or has an unhealthy colour must be excised. These criteria comprise is the ‘4 Cs’ for muscle excision (Colour, Contractility, Consistency, Capillary bleeding) • Bone shattered by high-energy transfer will in many instances still have attachment to periosteum or muscle. • Such fragments must not be discarded. Loss of bone may result in malunion (e.g. shortening) or nonunion.

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