Dermal Fenestration With Negative Pressure Wound Therapy: A Technique for Managing Soft Tissue Injuries Associated With High-Energy Complex Foot Fractures

Poon, Henrietta; Cocq, Heather Le; Mountain, Andrew; Sargeant, I.D.

doi:10.1053/j.jfas.2015.08.014

Cited by 14 publications

(13 citation statements)

References 19 publications

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“…Consequently, attention has focused on the technical aspects of limb salvage, with various orthopaedic and plastic surgical techniques examined for their use in increasing the potential for treating these injuries. 12 …”

Section: Introductionmentioning

confidence: 99%

Outcomes following limb salvage after combat hindfoot injury are inferior to delayed amputation at five years

Bennett

Stevenson

Sargeant

et al. 2018

Bone & Joint Research

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ObjectivesThe surgical challenge with severe hindfoot injuries is one of technical feasibility, and whether the limb can be salvaged. There is an additional question of whether these injuries should be managed with limb salvage, or whether patients would achieve a greater quality of life with a transtibial amputation. This study aims to measure functional outcomes in military patients sustaining hindfoot fractures, and identify injury features associated with poor function.MethodsFollow-up was attempted in all United Kingdom military casualties sustaining hindfoot fractures. All respondents underwent short-form (SF)-12 scoring; those retaining their limb also completed the American Academy of Orthopaedic Surgeons Foot and Ankle (AAOS F&A) outcomes questionnaire. A multivariate regression analysis identified injury features associated with poor functional recovery.ResultsIn 12 years of conflict, 114 patients sustained 134 fractures. Follow-up consisted of 90 fractures (90/134, 67%), at a median of five years (interquartile range (IQR) 52 to 80 months).The median Short-Form 12 physical component score (PCS) of 62 individuals retaining their limb was 45 (IQR 36 to 53), significantly lower than the median of 51 (IQR 46 to 54) in patients who underwent delayed amputation after attempted reconstruction (p = 0.0351).Regression analysis identified three variables associated with a poor F&A score: negative Bohler’s angle on initial radiograph; coexisting talus and calcaneus fracture; and tibial plafond fracture in addition to a hindfoot fracture. The presence of two out of three variables was associated with a significantly lower PCS compared with amputees (medians 29, IQR 27 to 43 vs 51, IQR 46 to 54; p < 0.0001).ConclusionsAt five years, patients with reconstructed hindfoot fractures have inferior outcomes to those who have delayed amputation. It is possible to identify injuries which will go on to have particularly poor outcomes.Cite this article: P. M. Bennett, T. Stevenson, I. D. Sargeant, A. Mountain, J. G. Penn-Barwell. Outcomes following limb salvage after combat hindfoot injury are inferior to delayed amputation at five years. Bone Joint Res 2018;7:131–138. DOI: 10.1302/2046-3758.72.BJR-2017-0217.R2.

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Section: Introductionmentioning

confidence: 99%

Outcomes following limb salvage after combat hindfoot injury are inferior to delayed amputation at five years

Bennett

Stevenson

Sargeant

et al. 2018

Bone & Joint Research

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“…The soft tissues inevitably deteriorated from this point, commonly leading to large patches of frank necrosis over the dorsum and lateral side of the foot (Figure 1). 23…”

Section: Discussionmentioning

confidence: 99%

Salvage of Combat Hindfoot Fractures in 2003-2014 UK Military

Bennett¹,

Stevenson²,

Sargeant

et al. 2017

Foot Ankle Int.

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“…In general, VSD can signi cantly improve the blood circulation of wounds, thereby reducing tissue oedema and bacterial colonization [14], promoting the growth of granulation tissue and improving the wound healing rate. The negative pressure of the VSD can greatly inhibit the growth of bacteria and reduce the need for antibiotics [15]; by producing a relatively hypoxic environment on the wound surface without affecting the surrounding healthy tissues. However, we have often found that more necrotic tissue from deep wounds will soon be distributed in the VSD, especially when the wound is seriously polluted; at this time, it is necessary to replace the negative pressure suction device or rinse it.…”

Section: Introductionmentioning

confidence: 99%

Recombinant human epidermal growth factor combined with vacuum sealing drainage for wound healing in Bama pigs

Wei

Wang

et al. 2020

Preprint

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Background: Vacuum sealing drainage (VSD) and epidermal growth factor (EGF) both play an important role in the treatment of wounds. This study aims to explore the effect of the combination of VSD and EGF on wound healing and the optimal concentration and time of EGF.Methods: In this study, we tested the proliferation and migration capacity of HaCaT and L929 cells at different EGF concentrations (0, 1, 5, 10, and 100 ng/ml) and different EGF action times (2, 10, and 30min). A full-thickness skin defect model was established using male, 30-week-old Bama pigs. The skin defects were randomly divided follows: routine dressing change after covering with sterile auxiliary material (Control), continuous negative pressure drainage of the wound (VSD), continuous negative pressure drainage of the wound and injection of epidermal growth factor 10 minutes followed by removal by continuous lavage (V+E 10 min), and continuous negative pressure drainage of the wound and injection of epidermal growth factor 30 minutes followed by removal by continuous lavage (V+E 30 min). The wound healing rate, histological repair effect and collagen deposition were compared among the four groups.Results: An EGF concentration of 10 ng/ml and an action time of 10 minutes had optimal effects on the proliferation and migration capacities of HaCaT and L929 cells. The drug dispersion effect was better than drug infusion after bolus injection effect, and the contact surface was wider. Compared with other groups, the V+E 10min group promoted wound healing to the greatest extent and obtained the best histological score. Conclusions: A rhEGF concentration of 10 ng/ml can promote the proliferation and migration of epithelial cells and fibroblasts to the greatest extent in vitro. VSD combined with rhEGF kept in place for 10 minutes and then washed, can promote wound healing better than the other treatments in vivo.

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Dermal Fenestration With Negative Pressure Wound Therapy: A Technique for Managing Soft Tissue Injuries Associated With High-Energy Complex Foot Fractures

Cited by 14 publications

References 19 publications

Outcomes following limb salvage after combat hindfoot injury are inferior to delayed amputation at five years

Outcomes following limb salvage after combat hindfoot injury are inferior to delayed amputation at five years

Salvage of Combat Hindfoot Fractures in 2003-2014 UK Military

Recombinant human epidermal growth factor combined with vacuum sealing drainage for wound healing in Bama pigs

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