Acute complex traumas of the lower limbs: a modern reconstructive approach with negative pressure therapy (original) (raw)
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Negative pressure therapy for lower limb complex wounds
European Journal of Plastic Surgery, 2010
Management of lower limb wounds can present challenge to reconstructive surgeon if options for reconstruction are limited. The situation worsens when such patients have co-morbidities like trauma to vital organs, diabetes mellitus, and generalized disorders which impair wound healing. Negative pressure wound therapy has gained popularity in the management of wounds in the last decade. We have used a modified form of commercially available V.A.C TM because of its high cost and universal unavailability. Fifty-eight patients with 61 complex wounds of the lower limb were included in the study over a period of 3 years. The average number of dressing changes was 3.2 and average duration from start of therapy till the wound was ready for coverage was 13.5 days. Fifty-seven wounds were skin grafted and four wounds were covered with local turnover flaps. We have found the modified vacuum dressing to be an effective technique for treating challenging wounds of the lower limb when options for reconstruction are limited.
Medical Science
A novel technique for fixing skin grafts combines vacuum-assisted closure (VAC) with a dressing based on the bacterium Chlorhexidine gauze. In this instance, the patient came to us with substantial degloving damage to the left lower leg due to a crushing injury, with exposed femoral vessels and a knee capsule. He was on fluids and blood transfusions when we arrived. Emergency debridement was performed, the exposed vessels were covered with a sartorius flap, the exposed patella was covered with a gastrocnemius flap and both were then covered with a VAC dressing. Later, a serial meshed grafting was performed and each was covered with a VAC dressing. We, here aim to demonstrate that it is preferable to use VAC dressing over grafting for improved graft uptake and to reduce the need for frequent dressing changes in cases of pain and soakage. One week after dressing removal the rate of skin transplant acceptance was measured. In the same patient, the VAC dressing method is contrasted with traditional bolster dressing over the foot. Compared to the tie-over bolster technique the VAC plus chlorhexidine-based dressing region shows higher skin graft uptake rates and reduced levels of discomfort. There was graft loss over the foot where we used conventional dressing.
The use of negative pressure therapy for the treatment Of lower-extremity wounds
Al-Azhar International Medical Journal, 2020
Background: lower extremity wounds with exposed bone, tendon or orthopedic hardware present a difficult treatment challenge. Objective: The purpose of this study is to assess the role of the vacuum assisted closure (VAC) therapy in the management of lower extremity wounds. Material and methods: A prospective analytic cohort study was conducted among 15 patient referred for reconstruction of lower extremity wounds. The study was conducted between January 2019 to June 2019. The wounds were inspected, surgical debridement was done if needed, and the VAC dressings were changed every 72 hours. Primary outcome was wound healing and granulation tissue formation. Secondary outcome was wound infection and wound size. Results: Vacuum-assisted closure therapy greatly decreases the surface area of the wound. Profuse granulation tissue formed rapidly, covering the bone and hardware. There was no statistically significant difference between the included patients regarding the pattern of wound infection pre and after negative pressure therapy (p=0.655). Results were both functionally and aesthetically satisfactory. Conclusion: VAC therapy appears to be a simple and more effective than conventional dressings for the management of difficult wound in terms of reduction in wound volume, depth, treatment duration and cost minimize the number of local and free-flap transfers.
Journal of Orthopaedics and Traumatology, 2013
Lower limb reconstruction with pedicled or free flaps can be commonly compromised by venous insufficiency. This complication often leads to partial/ complete flap necrosis and increases the risk of superinfection. Negative-pressure wound therapy (NPWT) is known to increase local blood flow, decrease edema, promote tissue granulation, and reduce the likelihood of soft tissue infection. This study aims to evaluate the effectiveness of NPWT in the treatment of congested pedicled and free flaps of the lower limb after reconstructions in lower limb traumas. A retrospective analysis was performed on four congested (pedicled and free) flaps on the lower limbs. NPWT was applied in all cases after partial flap debridement. NPWT was able to improve and resolve tissue edema and venous insufficiency, avoid further flap necrosis, and promote granulation. On NPWT removal, a split-thickness skin graft was applied on the wound, achieving complete and uneventful healing. NPWT is a useful instrument in managing flaps affected by venous insufficiency in lower limb reconstruction, although larger studies are necessary to better define the effectiveness and indications of NPWT in this setting.
International Journal of Orthopaedics Sciences
Background: Post operative wound dehiscence is a significant health problem. In imposes social and financial burdens. If the injury involves the exposure of bone, early coverage of the defect must be a goal of treatment to prevent secondary problems such as an osteogenic infection. Vacuum-assisted closure (VAC) therapy has been developed as an alternative to the standard forms of wound management, which incorporates the use of negative pressure to optimise conditions for wound healing and requires fewer painful dressing changes. It is a wound management system that exposes a wound bed to local negative pressure to promote healing. This article reviews the use of VAC therapy in a post operative of wound. Material and method: A prospective study conducted in department of orthopaedic surgery, Grant medical college and sir JJ Group of hospital, Mumbai from 2016-2017. A total of 25 subjects were consecutively recruited. Patients included in study are classified according to the grade of the ulcer. Patients age group 21-70 years with the following risk factors and comorbidities diabetes mellitus, hypertension, chronic obstructive pulmonary disease, dyslipidaemia, and smoking. Post operative wound dehiscence of proximal tibia, distal tibia and olecranon selected. Pre and post VAC culture collected. Patients were evaluated post VAC after definitive management for functional outcome. Result: Our study of confirms that vacuum assisted closure is an excellent treatment modality for post operative wound dehiscence. Patients had an average of 8 treatment sessions. The duration of VAC application ranged from 12 to 36 days with an average hospital stay of 24 days. Amongst this maximum patients being in the age group of 30-70 years. VAC dressing found to produce more secondary closure of wound and split skin graft, also reduced more invasive procedures like flap surgery and in worst case amputation. Also it found reduces bacterial count of the wound. Conclusion: Promotes early rehabilitation, and alleviates the need for a second procedure. Significant reduction in hospital stay subsequent lower in hospital cost, decreased amputations, increasing the number of patients undergoing skin grafting and improving culture sterility.
International Journal of Orthopaedics Sciences, 2019
Introduction: Wound healing is a complex, dynamic process and delayed wound healing significant health problem in India. Various type of surgical methods have been developed for wound healing such as Advanced Wound Care Therapies (AWCT)/ Vacuum-Assisted Closure (VAC) and myo-cutaneous or fascio-cutaneous tissue transfers, Stander dressing therapy etc. VAC Therapy is a Non-Invasive therapy. This therapeutic technique using for the management of large chronically infected wounds more recently used in the treatment of traumatic wounds and non-healing wounds. Aim: Aim of this study is to evaluate functional outcome of vacuum-assisted closure (VAC) dressing therapy for the management of non-healing wounds and traumatic wounds. Materials and methods: Our study was conducted on 30 patients in the Department of Orthopaedics, Kamineni Hospital, LB Nagar Hyderabad from May 2017 to June 2018. Out of 30 patients 18 male and 12 females, Mean age ranging from 19 to 58 for males and 20 to 60 for females. In our study, maximum cases were reported Road traffic accident 20 (67%) patients, followed by machinery injury in 6 (20%) patients and 4 (13%) patients had a fall from height. Vacuum Assisted Closure (VAC) dressing therapy applied for non-healing wounds and traumatic wounds. Results: Out of 30 wounds taken in the study, 20 wounds reduced in area & were resurfaced with split thickness skin grafting and 5 wounds showed reduction in area & were subjected to secondary closure. During start of VAC dressing therapy, all wounds were infected. At the end of VAC dressing, all wounds became swab negative during course of VAC dressing therapy, no patient required surgical debridement and there was gradual decrease in size of wound. Discussion: Our study showed that in VAC dressing therapy after day 3, there were 40% of patients who had no bacterial growth, and on day 7 there were 88% of patients who growth, whereas in saline-wet-tomoist patients only 10% of patients had no bacterial growth on the 8th day. Our study showed that VAC dressing therapy increases the vascularity and rate of granulation tissue formation compared to standard wound dressing therapy. Conclusion: VAC dressing provides sterile and controlled environment to large, educating wound surfaces by controlled application of sub-atmospheric pressure and prepares wounds for closure through split skin grafting and secondary closure in short time leading to less overall morbidity with decreased hospital stay.
Vacuum assisted closure therapy versus standard wound therapy for compound fractures
IP Innovative Publication Pvt.Ltd, 2017
Introduction: Compound fractures are surgical emergencies which require both skeletal stability as well as adequate soft tissue coverage. Debridement of all the dead and necrotic tissue can result to large soft tissue defects. Vacuum assisted closure therapy is a newer modality which can overcome all these problems and accelerates wound healing when applied to open wounds. Aim and Objectives: To analyse and compare the results of vacuum assisted closure therapy and standard wound therapy in management of compound fractures. Materials and Methods: 30 patients having compound fractures upto grade IIIB (Gustilo and Anderson classification) were randomly treated either using SWT or VAC therapy between November 2014 to June 2016. There were 15 patients in each group. After initial wound debridement and provisional fracture fixation, therapy was started and continued till the wound got optimized for coverage either by split skin graft or flap. Results: The mean time taken by wound to get optimized for coverage in the VAC therapy group was 10.13 ± 2.55 days whereas in SWT group was 11.20±1.65 days. The mean rate of decrease in size of wound by VAC therapy was 1.5453 ± 0.5855% whereas by SWT was 1.0587 ± 0.3637%. Infection was seen in 02 patients in the VAC group and in 05 patients in the SWT group. Conclusion: VAC therapy is superior to SWT in terms of rate of decrease in size of wound, lesser infection rate and shorter time for wound to get optimized for coverage.
Prosthetics and orthotics international, 2011
Stump healing is critical to post amputation management. When healing is not optimal, immobility is prolonged and patients risk hospital acquired deconditioning. Two clinical cases with unhealed trans-femoral stump wounds are described. Vacuum assisted closure (VAC) dressing with concurrent prosthetic utilisation was undertaken successfully in both cases. Fitting of the prosthetic socket included space for VAC dressing with modifications to allow the suction piping to exit the prosthesis. With VAC application, timely rehabilitation and mobility was enabled despite incomplete wound healing. The two clinical cases described made excellent progress. Discharge home was expedited with the provision of portable VAC pumps. Wounds healed fully without infection. Both patients were able to mobilise sooner than if they had to wait for complete wound closure and, importantly, the consequences of prolonged immobility were minimised. No extra costs were incurred using this novel therapy. Guidanc...