ResidentTraumaFINALhighres

237 / 242

235
intervention, it is better to treat the patient in the operating room
initially.
B. Immediate Primary versus Delayed Closure of
Contaminated Soft Tissue Wounds
1. Risk of Infection
PRO primary closure—Because of the “privileged” vascular supply to the
face, scalp, and neck, the likelihood is high that primary closure of
contaminated wounds, after appropriate cleansing, will be successful.
CON primary closure—It is risky to close a contaminated wound primar-
ily, due to the risk of methicillin-resistant Staphylococcus aureus (MRSA)
and other infectious agents. It is better to clean the wound over 2–3
days and then close it in a delayed fashion.
2. Cost Considerations
PRO primary closure—Considerations in this controversy include the
cost of early discharge after primary closure.
CON primary closure —There is risk of more expensive readmission and
intensive care if infection occurs.
3. Use of Metal Alloy or Resorbable Fixation Plates
PRO metal alloy plates—Metal alloy fixation plates reduce the risk of
mobility at tension fracture sites and the risk for nonunion.
CON metal alloy plates—Metal alloy plates are more thermal conductive
than the absorbable plates and may require removal for discomfort.
PRO resorbable fixation plates—Resorbable fixation plates reduce stress
shielding over time at tension fracture sites.
CON resorbable fixation plates—Most resorbable fixation plates are
higher profile, and thus more palpable, than the metal alloy fixation
plates.
III. Final Considerations
These examples are provided to emphasize that trauma care decisions
and options by otolaryngologist–head and neck surgeons have variation
across the United States, occurring within the general framework of
clinical guidelines, best practices, and best evidence. Your attending
faculty may have a practice protocol or philosophy, based on good
scientific principles, that varies somewhat from the general recommen-
dations contained in this Resident Manual. Yet, the information we