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U da ed: 11/22/2019 40

O F M
Leah Ahn Ben Sha a eh Benjamin C. Ta lo

TOPIC QUESTIONS EVIDENCE VIDEOS CASES

Re ie To ic 19 / 19 17 / 17 2 /2 7 /7

O e ie
o en f ac e a e f ac e i h di ec comm nica ion o he e e nal en i onmen
ea men e i e immedia e IV an ibio ic and gen i iga ion and deb idemen
E idemiolog
incidence
30.7 e 100,000 e on e ea
demog a hic
a e age age i 45 ea old
loca ion
ibia and halan a e mo common
Pa ho h iolog
mechani m of inj
high-ene g a ma
"in ide-o " o en f ac e
A ocia ed condi ion
of en a ocia ed i h addi ional inj ie (30%)
com a men nd ome
he e ence of an o en o nd doe no ecl de he occ ence of com a men
nd ome in he inj ed limb
P ogno i
in he ab ence of life- h ea ening inj ie , he e i no clinical ad an age o e fo ming
ge i hin 6 ho of inj e 6-24 ho
con amina ion i h di and deb i and de i ali a ion of he of i e inc ea e he i k
of infec ion and o he com lica ion

C
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G ilo cla ifica ion

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Hi o
ob ain info ma ion ega ding mechani m, loca ion, and iming of inj
Ph ical e am
a e of - i e damage
he i e and na e of he e e nal o nd ma no eflec he damage o he
dee e c e
e fo m ne o a c la e am
if conce n fo a c la in l , ankle b achial inde (ABI) ho ld be ob ained
no mal a io i > 0.9
a c la ge con l and angiog am i a an ed if ABI < 0.9
con ide aline load e o CT can if conce n fo a ma ic a h o om
ome die no ho CT can mo e en i i e han aline load e

Radiog a h
indica ion
ob ain adiog a h incl ding join abo e and belo f ac e

Nono e a i e
I , ,

indica ion
ini ial ea men fo all o en f ac e
a of i e o nd in o imi o a f ac e ho ld be ea ed a an
o en f ac e n il o en o he i e
an ibio ic e indica ed b inj a e n and loca ion ( ee echni e belo )
O eai e
I&D, ,
indica ion
con ide I&D a oon a o ible, ma be beneficial i hin 6 ho in e m
of dec ea ing infec ion i k
ideal ime of of i e co e age con o e ial, b mo cen e e fo m
i hin 5 da

indica ion
once of i e co e age i ob ained and an ade ae e ili i achie ed

A
iming
ini ia e a oon a o ible
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die ho
inc ea ed infec ion a e hen an ibio ic a e dela ed fo mo e
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con in e fo 24 ho af e ini ial inj if o nd i able o be clo ed ima il

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con in e fo 24 ho af e final clo e if o nd i no clo ed d ing ini ial gical
deb idemen (72 ho fo e III o nd )
e
G ilo e I and II
1 gene a ion ce halo o in
clindam cin o ancom cin can al o be ed if alle gie e i
G ilo e III
1 gene a ion ce halo o in + aminogl co ide
fa m inj ie , hea con amina ion, o o ible bo el con amina ion
add high do e enicillin fo anae obic co e age (clo idi m)
ecial con ide a ion
f e h a e o nd
fl o o inolone o 3 d o 4 h gene a ion ce halo o in
al a e o nd
do c cline + cef a idime o a fl o o inolone

iming
ini ia e in eme genc oom o a ma ba
o fo m of o h la i
o oid
0.5 mL, ega dle of age
imm noglob lin
< 5 ea old ecei e 75 U
5-10 ea old ecei e 125 U
>10 ea old ecei e 250 U
o oid and imm noglob lin ho ld be gi en in am c la l i h o diffe en
inge in o diffe en loca ion
g ideline fo e an o h la i de end on 3 fac o
com le e o incom le e accina ion hi o (3 do e )
da e of mo ecen accina ion
e e i of o nd
E S &D
abili a ion
lin , b ace, o ac ion fo em o a abili a ion
dec ea e ain, minimi e of i e a ma, and e en di ion of clo
d e ing
emo e g o deb i f om o nd, do no emo e an bone f agmen
lace e ile aline- oaked d e ing on o nd
li le e idence o o agg e i e i iga ion o i iga ion i h an i e ic ol ion
in he ED, a hi can h deb i f he in o o nd
I &D
iming
da a i conflic ing b mo cen e e fo med i iga ion i hin 6 ho
aged deb idemen and i iga ion
e fo m e e 24 o 48 ho a needed
echni e
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inci ion
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e o e f ac e b ec ea ing EA mechani
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and di all in line i h e emi

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i iga ion
lo - e e b lb i iga ion . high- e e l e la age
die ha e ho n ha lo e e b lb i iga ion i le e en i e
han high e e l e la age and ha no diffe ence in infec ion a e
aline . aline i h ca ile oa . an ibio ic ol ion
die ha e ho n ha aline i h ca ile oa had dec ea ed
ima o nd healing oblem hen com a ed o an ibio ic ol ion
on a e age, 3L of aline a e ed fo each cce i e G ilo e
T e I: 3L
T e II: 6L
T e III: 9L
deb idemen
ho o gh deb idemen i c i ical o e en ion of dee infec ion
bon f agmen i ho of i e a achmen ho ld be emo ed
an ibio ic bead
indica ion
can lace an ibio ic bead- o ch in o en di o nd
bead made b mi ing me h lme hac la e i h hea - able an ibio ic
o de
S C
iming
ea l of i e co e age o o nd clo e i ideal
iming of fla co e age fo o en ibial f ac e emain con o e ial, < 5
da i de i ed
inc ea ed i k of infec ion be ond 7 da
echni e
can oceed i h bone g af ing af e o nd i clean and clo ed
nega i e- e e o nd he a ma be ili ed d ing deb idemen n il
defini i e co e age can be achie ed (inc ea ed i k of infec ion if o en >7 da )
R B L
echni e
Ma ele echni e ("ind ced-memb ane" echni e)
2 age echni e
1 age: I&D, cemen ace and em o i ing fi a ion
2nd age: lacemen of bone g af in o "ind ced memb ane" and
defini i e fi a ion
S die ho o imal ime f ame fo bone g af ing o be 4-6 eek
af e lacemen of cemen ace
di ac ion o eogene i
a c la i ed bone fla / an fe

Infec ion
Ne o a c la inj
Com a men nd ome

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can ill occ in he e ing of o en f ac e

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Plea e a e o ic. A e age 4.2 of 126 Ra ing

QUESTIONS (19)

QUESTIONS
P e io Ne
4 of 19

(SBQ12FA.68) A 25- ea -old male e en o he eme genc de a men af e a la nmo e

acciden i h a ma ic lo of hi g ea oe. On e amina ion, hi o nd i g o l con amina ed
i h oil. In addi ion o a ce halo o in and an aminogl co ide, enicillin i gi en. Which of he
follo ing i e i h ega d o he o gani m ha enicillin i a ge ing in hi inj ? Re ie To ic
Te ed Conce
QID: 3875

1 t is an Aerobic, Gram-positi e rod

2 t is an Anaerobic, Gram-positi e coccus

3 t is an Anaerobic, Gram-negati e rod

4 t is Catalase positi e

5 t ma cause botulism

Selec An e o ee P efe ed Re on e

EVIDENCES (36)

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VIDEOS (2)

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T a ma - O en F ac e Managemen

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T a ma - O en F ac e Managemen

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T a ma - O en F ac e Managemen 1

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T a ma - O en F ac e Managemen 6

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