[Sacamuelas]

14 days... well, we gotta do something then.

I like what James has said. However, I might change a few things just to be different! LOL

I would do the following:

1.Don't know if I read James's post correctly or not. If he meant an AND in there instead of a comma then I don't disagree. I just don't consider a 3rd generation ceph alone as a broad enough spectrum coverage drug for a penetrating wound.

Initally, I might use a broader spectrum 1st generation ceph or a 3rd generation penicillin like ampicillin. 3rd Cephs have a greatly reduced staph and strep affect and are more selective for gram (-) only and have a little Pseudo. A. coverage.
I was always taught to use broad spectrum unless you know you have something else working. Theother two listed are give good basic gram (-) coverage and still have a good staph/strep efficacy.


2. I would consider this wound "instantly" contaminated and infected. I would remove the object once proper prepping of the wound and anesthesia is provided as James wrote(don't know what general anestetics would be available to you in UWOA).

3. Evaluate the object. I would scrub that object with betadine before removal to prevent further contamination. Also, modification of the end that will be passing back through can be accomplished to remove any projections and decrease its circumference to ease withdrawal.

4. Incise and remove as described.

5. Do as James has listed... particularly noting the likely position of the expected major anatomy that could be further comprimised during removal and suturing. An ounce of prevention concerning the nerves or arteries could be worth its weight in gold.

6. I would close internally (by layers) with resorbable sutures and finish the wound with nylon externally.

I pretty much agree with James. Only a few personal choice differences I think. What did we miss?

What layer(s) in this particular type wound would the drains be placed for maximum effectiveness?