Vacuum assisted closure therapy for treatment of complex wounds in replanted extremities

Abstract

The object of this study was to compare the outcomes of the vacuum assisted closure (VAC) therapy and conventional wound care with dressing change for treatment of complex wounds in patients with replantation of amputated upper and lower extremities. Data of 43 patients with replantation of amputated extremities from May 2004 to December 2011 were reviewed. There were 18 wounds of 18 patients with replantation, which were treated by dressing change and 26 wounds of 25 patients by VAC therapy. The outcomes were evaluated by the survival rate of replanted extremities, growth of granulation tissue, interval between wound treatment and secondary procedure and eventual secondary wound coverage methods. Vascular thromboses were found in 3 patients with wound treatment by dressing change and 5 by VAC. All replants of two groups of patients survived after salvage procedures. The wound score was 3.6 ± 0.7 in the conventional dressing change group and 5.8 ± 0.7 in the VAC group at the sixth day after treatment, respectively. The intervals between wound treatment and secondary wound coverage procedure were 12.0 ± 1.7 days in the dressing change group and 6.1 ± 0.7 days in the VAC group. Flaps were applied for wound coverage in 9 out of 18 (50.0%) wounds in the dressing change group and 5 out of 26 (19.2%) in the VAC group (P < 0.05), when the wounds of rest of patients were covered by the skin graft. The results showed that VAC could promote the growth of granulation tissue of wound, decrease the need of flap for wound coverage, and did not change the survival of replantation.

Is delayed reconstruction using the latissimus dorsi free flap a worthy option in the management of open IIIB tibial fractures?

“…NPWT is commonly used as a bridging therapy from the emergency operation to definite coverage, and this occlusive clean dressing methodology can prevent the spread of infection . However, in open tibial IIIB fractures, delayed closure and prolonged application of NPWT leads to higher rates of infection and amputation .…”

Coverage of supraumbilical abdominal wall defects: The tunnelled‐pedicled ALT technique

“…A vacuum assisted system has been proved a useful tool for this purpose, providing temporal coverage in contaminated wounds. Negative pressure closure technique increase vascularization, decrease edema, increase local granulation tissue, potentially decreasing bacterial colonization …”

“…Negative pressure closure technique increase vascularization, decrease edema, increase local granulation tissue, potentially decreasing bacterial colonization. 18,19 We successfully employed a homemade vacuumassisted system for temporal wound coverage, until the general condition of the patients allowed for secondary reconstruction. The use of negative pressure wound therapy for temporary abdominal closure is well established and a systematic review has been recently published.…”

Reconstruction of severely infected gluteal osteoradionecrosis using negative‐pressure wound therapy and latissimus dorsi musculocutaneous flaps

“…It helps to remove excess fluid and debris, decrease tissue bacterial levels, improve tissue perfusion, and promote wound healing by creating a barrier and a subatmospheric pressure . Moreover, recent reports have highlighted the use of NPWT in open fractures, for wounds associated with exposure to implants or hardware, and to assist in wound closure of deep wound infections in combination with flap transfer . Radical debridement and negative‐pressure dressings are useful for stabilizing osteomyelitis wounds prior to resurfacing and reconstruction .…”