Post-Traumatic Blister Management

Post-traumatic blister is often encountered in high-energy injuries and following major limb surgeries. Currently, there is very limited evidence concerning blister management resulting in a lack of comprehensive guidelines for their management. The survey-based study was conducted by Siddhartha Sinha et al to appraise the current consensus in post-traumatic management among the practising orthopaedic surgeons and compare the same with the evidence in the literature.

The authors conducted an online questionnaire-based survey of orthopaedic surgeons concerning post-traumatic blister management practices. The questionnaire mainly focused on antibiotic prophylaxis, local invasive procedures, antiseptics dressings and additional treatment options regarding blister management. The target population for the survey was the practising orthopaedic surgeons with minimum qualification of a post-graduate degree in orthopaedics and who regularly manage trauma cases.

The questionnaire included open-ended and closed-ended questions formulated by two senior authors with over ten years of experience in orthopaedic trauma management.

The two analysing authors independently categorised the responses, and the response categories were finalised after subsequent discussion and mutual consensus. The frequencies of each of the categorical responses were then calculated.

Observations of the Study

• A high prevalence (~78%) of systemic antibiotics administration was noticed for post-traumatic blister management. Similarly, a large section of respondents (66.4%) advocated for either de-roofing or aspiration of blisters.
• Approximately 42% of respondents preferred sending blister fluid for cultures.
• More than half of the respondents used some form of local dressing to cover the blister bed to provide a healing environment.
• Additional opinions mostly included anti-inflammatory and swelling reducing measures.
• Few respondents also advocated for oral steroids for inflammation control.

The authors concluded that the current study suggests a wide variation in the post-traumatic blister management practices among orthopaedic surgeons. The limited evidence available in literature could be the potential contributing factor for such differences in clinical practices. The general measures to reduce soft-tissue oedema include cryo-therapy, limb elevation and rest, anti-inflammatory measures, splinting, and non-invasive measures like limited external fixation, blister aspiration and de-roofing in large blisters, and local antimicrobials moist dressing have been supported by the literature. However, the use of systemic antibiotics and steroids has not been supported by the literature and should be avoided unless indicated due to other reasons. Further evidence is required to strengthen the recommendations for post-traumatic blister management.

Further Reading

The Current Consensus on the Management of Post-traumatic Blisters Among Orthopaedic Surgeons
Siddhartha Sinha, Arvind Kumar et al
Indian Journal of Orthopaedics (2022) 56:1011–1017
https://doi.org/10.1007/s43465-022-00612-9