Extensive wound dehiscence and wide plate and screw exposure in the early weeks following orthopaedic surgery in children is usually managed either by extensive debridement, lavage and secondary closure when possible or hardware removal and external fixation. The purpose of this paper was to report on 4 children with wide plate exposure and who were managed conservatively without any redo surgery.

Four children with wide plate and screw exposure were managed by simple repetitive debridement and local wound care with intermittent oral antibiotics when needed and without any IV antibiotics, nor secondary closure or hardware removal. All four cases occurred in the tibia, two following tibial osteotomy in lateral hemimelia with a long history of previous surgeries, one following wide excision of a tibial Ewing sarcoma and radiotherapy, and the fourth following wide excision of a 12cm necrotic tibial segment due to chronic osteomyelitis. The plates used were locked plates (LCP) in all four cases.

Healing was uneventful in 3 followed by hardware removal. Spontaneous soft tissue healing occurred thereafter. The case of Ewing sarcoma is progressing nicely and shows good signs of healing but still not enough to remove the hardware.

We believe that a stable fixation may lead to a good bone healing despite an extensive wound dehiscence and a wide plate and screw exposure with just a proper local wound care and without any major additional surgery. The two key factors for success seem to be the use of locked plates, which mechanically act as external fixators as well as scrupulous wound care.