Antibiotic impregnated beads in open fractures. A report on the technique and possible applications in military surgery.

The use of antibiotic impregnated beads has been shown to be a valuable adjunct in the prevention of infection in open fractures. The bead pouch technique employs these beads within the wound, producing high local levels of antibiotic in a moist environment. This effectively inhibits bacterial colonisation and wound infection whilst preventing desiccation of structures such as bone and tendons. This technique can be used to manage wounds until soft tissue cover is obtained, whether by delayed primary suture or by plastic surgical means. The potential use in acute military surgery includes the management of wounds associated with fractures, damage to tendons or neuro-vascular injury. In such cases delay in soft tissue cover may be clinically necessary or dictated by casualty evacuation to rearward surgical facilities. The bead pouch technique offers a means of managing the wound between initial wound surgery and soft tissue cover.