Traumatic and surgical wounds

In the management of any potentially contaminated wound, but
particulary where contamination may be severe, the immobilisation of the
limb is the single most important step - and this was not mentioned by
this author. Again, the vital lessons of the past have been forgotten (or
neglected by the reliance on antibiotic therapy).

Trueta showed, in his publications, that infection spreads by the
movement of tissue planes. If the wounded limb is held still in an
occlusive plaster-of-Paris cast that immobilises the joint above and the
joint below, and the wound is carefully excised and loosely packed with
dry, sterile cloth, infecting organisms will be contained on the wound
surface and will not spread into the surrounding healthy tissues.
Antibiotics are unnecessary; but must, today, be given to avoid criticism
on those occasions when there is local abscess formation.

All non-surgical wounds should be splinted where this is anatomically
feasible.

Trueta J.& Barnes JM. (1940)The rationale of complete
immobilization in treatment of infected wounds. Brit. Med. J. ii. 46.

Competing interests:
Quondam SHO to Professor J Trueta