Vacuum Assisted Closure Therapy versus Standard Wound Therapy for Open Musculoskeletal Injuries

Abstract

Background. This study was performed to evaluate the results of vacuum assisted wound therapy in patients with open musculoskeletal injuries. Study Design and Setting. Prospective, randomized, and interventional at tertiary care hospital, from 2011 to 2012. Materials and Methods. 30 patients of open musculoskeletal injuries underwent randomized trial of vacuum assisted closure therapy versus standard wound therapy around the upper limb and lower limb. Mean patient age was 39 ± 18 years (range, 18 to 76 years). Necrotic tissues were debrided before applying VAC therapy. Dressings were changed every 3 or 4 days. For standard wound therapy, debridement followed by daily dressings was done. Data Management and Statistical Analysis. The results obtained were subjected to statistical analysis. Results. The size of soft tissue defects reduced more than 5 mm to 25 mm after VAC (mean decrease of 26.66%), whereas in standard wound therapy, reduction in wound size was less than 5 mm. A free flap was needed to cover exposed bone and tendon in one case in standard wound therapy group. No major complication occurred that was directly attributable to treatment. Conclusion. Vacuum assisted wound therapy was found to facilitate the rapid formation of healthy granulation tissue on open wounds in the upper limb and lower limb, thus to shorten healing time and minimize secondary soft tissue defect coverage procedures.

In Vivo Assessment of Protease Dynamics in Cutaneous Wound Healing by Degradomics Analysis of Porcine Wound Exudates

“…Importantly, it was sufficient to monitor the decline of the inflammatory response and the onset of granulation tissue formation (e.g. deposition of type III collagen), a critical turning point in negative pressure wound therapy in the clinics (67). Thus, our work provides evidence for feasibility to develop novel highly discriminant multi-parameter point-of-care tests for impaired wound healing by recording the proteome and proteolytic signatures from wound fluids noninvasively obtained during NPWT.…”

Approach to Complex Upper Extremity Injury: An Algorithm

“…17 Although its exact mechanism of action remains unclear, VACtreated wounds have been found to be less edematous, to have formed granulation tissue more rapidly for earlier coverage of exposed osseotendinous structures and hardware, and are capable of reducing wound sizes significantly compared with standard dressing therapy. 18 Vacuumassisted closure therapy also improves blood flow to the wound bed, and in turn enhances antibiotic therapy for eradicating infections. 19 Moreover, this strategy of deliberate delay is in accordance with the principles of damage control in orthopedics, which aims to avoid the second-hit phenomenon that can jeopardize the reconstruction.…”

“…Once the wound bed is deemed ready for closure by the surgeon, either after primary radical debridement or after serial debridement with the adjunctive use of VAC in concert with negative wound cultures, the final extent of reconstruction required will present itself and can normally be addressed using the reconstructive ladder. In most scenarios, the extent of injury will preclude primary closure, but delayed reconstruction with VAC has been demonstrated to decrease both the size of the wound 18 and thus the complexity of reconstruction required. 21 Local, random pattern, or perforator-based flaps may thus be utilized with the additional benefit of a better tissue match for optimal aesthetics.…”

The Use of Negative Pressure Therapy for the Treatment of the Defects on Extremities due to High-Energy Trauma

“…In extremity injuries caused by high energy trauma, it is necessary to remove the dead tissue from the site and properly close the soft tissue in order to protect the affected extremity from amputation. Soft tissue defects in the extremities are caused by the effects of trauma and posttraumatic debridements (1,2). The surgical method which will be used in closing the defect is decided according to the size of the wound, whether there are tissues such as bone or tendon at the base of the wound, and exposure of the implants used in stabilizing the bone.…”