SUMMARY OF CHANGES

1. New references have been added based on clinical data from the Fluid Lavage of Open Wounds Study and improved outcomes seen with newer techniques in peripheral nerve management.
2. Although recent clinical data is inconclusive as to which irrigation method is superior, additives such as iodine or castile soap should not be added to the irrigation solution when irrigating open wounds.
3. Recommendations are made to avoid traction neurectomies acutely, when possible, to allow for targeted muscle reinnervation if deemed appropriate at the time of definitive wound closure.
4. Recommendation to NOT amputate through the most proximal fracture if stabilization of the fracture can result in an improved functional outcome and the associated wounds make salvage at the more distal level possible.
5. Recommendations made that if using negative pressure wound therapy (NPWT) during transport, consideration should be made to use antibiotic beads (if available) under the NPWT dressing if vacuum dressing fails.