Minimizing treatment complexity of combat-related soft tissue injuries using a dedicated tension relief system and negative pressure therapy augmented by high-dose in situ antibiotic therapy and oxygen delivery: a retrospective study

Abstract

Background Following combat-related, extensive soft tissue injury from gunshot wounds or blasts, prolonged duration from injury to full wound closure is associated with infection, increased morbidity and mortality, failure to mobilize, poor functional outcome and increased cost. The purpose of this study was to evaluate a novel treatment enabling early primary closure of combat wounds. Methods This was a retrospective study of 10 soldiers and civilians with extensive combat-related soft tissue limb injuries (5 gunshot wounds, 5 blasts) treated using the TopClosure® Tension Relief System (TRS) with simultaneous administration of regulated oxygen-enriched and irrigation negative pressure-assisted wound therapy (ROINPT) via the Vcare α® device. Results Nine patients were treated during the acute phase of injury and one was treated following removal of a flap due to deep infection 20 years after injury and flap reconstruction. Two patients had upper limb injury and the rest lower limb injury. With the aid of the TRS and/or ROINPT, immediate primary closure during reconstruction was achieved in 6 patients and delayed primary closure in three. Only one patient required a skin graft to close a small area of the wound after most of the wound had been closed by delayed primary closure. Wound closure was achieved within 0–37 days (median: 12.5 days, interquartile range: 2.75–19.75) from injury. Conclusions The TRS is a novel device for effective, early skin stretching and secure wound closure through the application of stress relaxation and mechanical creep, achieving primary closure of large defects using a simplified surgical technique and reducing the need for closure using skin grafts and flaps and the use of tissue expanders. Delivering supplemental oxygen to the wound by ROINPT reverses the reduced oxygen levels inherent in conventional negative pressure-assisted wound therapy, mitigating anaerobic contamination and reducing infection. Irrigation may accelerate the evacuation of infectious material from the wound and provide a novel method for antibiotic administration. The combination of TRS and ROINPT devices allow for early primary closure with improved functionality of combat-related limb injuries.

Efficacy and safety of external tissue expansion technique in the treatment of soft tissue defects: a systematic review and meta-analysis of outcomes and complication rates

“…High-energy injuries often result in severe soft tissue defects usually combined with bone injuries [ 76 ]. A total of 22 retrospective studies included 215 patients with soft tissue defects after trauma.…”

“…The wounds were mainly located in the extremities and trunks. The devices used for reconstruction of the posttraumatic defects included the vessel loop [ 25 ], SureClosure® [ 26 , 54 ], ETEs [ 55 ], Proxiderm® [ 30 , 69 ], Wisebands® [ 31 ], DermaClose® [ 57 , 77 ], TopClosure® [ 33 , 58 , 76 ], EASApprox® [ 60 ], KeKe® [ 43 , 75 ] and some homemade devices, such as nice knots [ 2 ], rubber bands [ 48 ] and KWs [[ 41 , 46 ],[ 72–74 ]].…”

“…Seven retrospective studies met the inclusion criteria for the meta-analysis of the median healing time of posttraumatic defects [ 2 , 25 , 30 , 57 , 69 , 72 , 76 ]. Kaplan–Meier survival analysis was used to analyse the median healing time.…”

“…External tissue expansion has been reported to decrease the wound closure time, hospital stay time and total wound care cost [ 95 , 98 ]. Notably, external tissue expansion may reduce the time to rehabilitation initiation following surgery [ 28 ], which may be a considerable advantage for battlefield applications compared with skin grafts and artificial dermis [ 76 ]. However, the effect of external tissue expansion has not exactly been confirmed by high-grade RCTs.…”

Israeli Innovations in the Field of Plastic Surgery

“…7 ). 35 37 38 Multiple devices can be placed perpendicular to the wound closure depending on the size of the defect.…”