The Use of Vacuum-Assisted Closure Therapy for the Treatment of Lower-Extremity Wounds with Exposed Bone

Abstract

Lower-extremity wounds with exposed tendon, bone, or orthopedic hardware present a difficult treatment challenge. In this series of patients, subatmospheric pressure therapy was applied to such lower-extremity wounds. Seventy-five patients with lower-extremity wounds, most of which were the result of trauma, were selected for this study. Dressings made of sterile open-cell foam with embedded fenestrated tubing were contoured to the wound size and placed into the wound. The site was covered with an adhesive plastic sheet. The sheet was placed beneath any external fixation devices, or the fixation device was enclosed within the sheet. The tubing was connected to the vacuum-assisted closure pump. Continuous subatmospheric suction pressure (125 mmHg) was applied to the wound site. The wounds were inspected and the dressings were changed every 48 hours.Vacuum-assisted closure therapy greatly reduced the amount of tissue edema, diminishing the circumference of the extremity and thus decreasing the surface area of the wound. Profuse granulation tissue formed rapidly, covering bone and hardware. The wounds were closed primarily and covered with split-thickness skin grafts, or a regional flap was rotated into the granulating bed to fill the defect. Successful coverage was obtained without complication in 71 of 75 patients. Wounds have been stable from 6 months up to 6 years.

Negative pressure wound therapy: eleven-year experience at a tertiary care hospital

“…NPWT has been shown to be useful in obtaining wound closure in various types of traumatic injuries including soft tissue defects involving exposed bone, tendon, or hardware. [31][32][33] The usefulness was also shown in the management of fasciotomies in of our patients which received NPWT followed by closure either by secondary intent or by skin grafting. 34 DeFranzo and colleagues reported a case series that observed NPWT applied to decreased edema of open fractures and decreased circumference of the extremity and size of the wound; 95% of wounds were successfully closed.…”

Tratamento cirúrgico de ferimentos descolantes nos membros inferiores: proposta de protocolo de atendimento

“…A terapia com pressão negativa proporciona imobilização do enxerto e permite a aspiração de debris, resultando em menor incidência de seroma e hematoma e em uma maior integração do enxerto. Também apresenta o efeito de diminuir a população bacteriana na ferida 13 . Há evidência clínica e experimental suficiente na literatura médica para preconizar a utilização desse curativo 11, 12, 14-16. No estudo em questão o aparelho a vácuo foi utilizado de maneira rotineira nos casos atendidos.…”

From Basic Wound Healing to Modern Skin Engineering

“…The negative pressure device can provide rapid formation of granulation tissues and its ability to decrease edema helps prepare the wound for simple wound-closure techniques. 14 …”