• Clean | GP: Staph and Strep | ‣ | Vaccine if > 10 yr | 3 L | I&D + ORIF + primary closure | | Grade II | - Wound 1-10 cm
• moderate soft tissue injury | Add GN | Add ‣ | Vaccine if > 5 yr Immune Globin | 6 L | I&D + ORIF + primary closure | | Grade III* | IIIA → extensive soft tissue injury IIIB → exposed bone, needs flap (plastic) IIIC → vascular damage, needs vascular | Add Anarobe | Add ‣ | Vaccine if > 5 yr Immune Globin | 9 L | I&D + ORIF/DCO* (A), DCO* (BC) + IIIA → often needs STSG IIIB → needs flap (plastic), delayed closure IIIC → needs vascular bypass, delayed closure |

*Grade III Prior Description

*- Wound > 10 cm

• Injury > 6 hours
• Gross contamination
• Soft tissue damage not repairable through primary intention
• Vascular Injury of Fracture*

****DCO = Damage control orthopaedics *STSG = split-thickness skin graft

Wound Appearance

Gustilo-Anderson Type I - III