Vacuum-assisted wound closure (VAC therapy) for the management of patients with high-energy soft tissue injuries.
OBJECTIVE
To evaluate the results of a vacuum-assisted closure device in patients presenting with open high-energy soft tissue injuries.


METHODS
Consecutive nonrandomized clinical study.


METHODS
From August 1999 through October 2000, 21 patients, with 21 high-energy soft tissue wounds (6 tibial, 10 ankle, and 5 with wounds of the forearm, elbow, femur, pelvis, and a below-knee stump) were treated with a vacuum-assisted closure device at a Level 1 trauma center.


METHODS
A negative atmospheric pressure device used for the management of complex open injuries. Infected wounds had dressings changed every 48 hours, whereas all others had dressings changed every 72 to 96 hours.


METHODS
The duration of vacuum-assisted closure use, final wound closure outcome, costs versus standard dressing changes or free flaps, and a list of all complications were recorded. All patients were followed for 6 months postcoverage.


RESULTS
Patients averaged 4.1 sponge changes, 77% performed at bedside, with the device used an average of 19.3 days. Twelve wounds (57%) required either no further treatment or a split-thickness skin graft, and 9 (43%) required a free tissue transfer.


CONCLUSIONS
The vacuum-assisted closure appears to be a viable adjunct for the treatment of open high-energy injuries. Application can be performed as a bedside procedure but additional soft tissue reconstruction may be needed for definitive coverage. This device does not replace the need for formal debridement of necrotic tissue, but it may avoid the need for a free tissue transfer in some patients with large traumatic wounds.
Herscovici
Dolfi
D
Othopaedic Trauma Service, Tampa General Hospital, Tampa, Florida 33637, USA. fixbones@aol.com
Sanders
Roy W
RW
Scaduto
Julia M
JM
Infante
Anthony
A
DiPasquale
Thomas
T
D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000601:surgery / Q000628:therapy*; D001458:Bandages; D003646:Debridement; D005260:Female; D050723:Fractures, Bone; D006801:Humans; D008297:Male; D008875:Middle Aged; D017695:Soft Tissue Injuries / Q000601:surgery / Q000628:therapy*; D015503:Surgical Sponges; D013530:Surgical Wound Infection / Q000628:therapy; D013978:Tibial Fractures / Q000601:surgery / Q000628:therapy*; D014618:Vacuum; D014945:Wound Healing