The size of injury on the skin surface does not necessarily reflect the extent of deep underlying soft tissue injury. Therefore, the true grading of Gustilo can only be done in operating theatre. Management
Acute management
Urgent interventions, including therapeutic irrigation and wound debridement, are often necessary to clean the area of injury and minimize the risk of infection. Other risks of delayed intervention include long-term complications, such as deep infection, vascular compromise and complete limb loss. After wound irrigation, dry or wet gauze should be applied to the wound to prevent bacterial contamination. Taking photographs of the wound can help to reduce the need of multiple examinations by different doctors, which could be painful. Limb should be reduced and placed in a well-padded splint for immobilization of fractures. Pulses should be documented before and after reduction.Wound cultures are positive in 22% of pre-debridement cultures and 60% of post-debridement cultures of infected cases. Therefore, pre-operative cultures no longer recommended. The value of post-operative cultures is unknown. Tetanus prophylaxis is routinely given to enhance immune response against Clostridium tetani. Anti-tetanus immunoglobulin is only indicated for those with highly contaminated wounds with uncertain vaccination history. Single intramuscular dose of 3000 to 5000 units of tetanus immunoglobulin is given to provide immediate immunity.Another important clinical decision during acute management of open fractures involves the effort to avoid preventable amputations, where functional salvage of the limb is clearly desirable.
DTaP-IPV vaccine is a combination vaccine whose full generic name is diphtheria and tetanus toxoids and acellular pertussis adsorbed and inactivated poliovirus vaccine (IPV).It is also known as DTaP/IPV, dTaP/IPV, DTPa-IPV, or DPT-IPV. It protects against the infectious diseases diphtheria, tetanus, pertussis, and poliomyelitis.Branded formulations marketed in the USA are Kinrix from GlaxoSmithKline and Quadracel from Sanofi Pasteur.Repevax is available in the UK.Within Japan, the formulation is called  四種混合（shishukongou - "mixture of 4"). Astellas markets it under the クアトロバック (Quattro-back) formulation, while another is available from Mitsubishi Tanabe Pharma named テトラビック (Tetrabic). A previous product by Takeda Pharmaceutical Company has been withdrawn by the company. == References ==