The use of vacuum assisted closure (VAC) in soft tissue injuries after high energy pelvic trauma.
BACKGROUND
Application of vacuum-assisted closure (VAC) in soft tissue defects after high-energy pelvic trauma is described as a retrospective study in a level one trauma center.


METHODS
Between 2002 and 2004, 13 patients were treated for severe soft tissue injuries in the pelvic region. All musculoskeletal injuries were treated with multiple irrigation and debridement procedures and broad-spectrum antibiotics. VAC was applied as a temporary coverage for defects and wound conditioning.


RESULTS
The injuries included three patients with traumatic hemipelvectomies. Seven patients had pelvic ring fractures with five Morel-Lavallee lesions and two open pelviperineal trauma. One patient suffered from an open iliac crest fracture and a Morel-Lavallee lesion. Two patients sustained near complete pertrochanteric amputations of the lower limb. The average injury severity score was 34.1 +/- 1.4. The application of VAC started in average 3.8 +/- 0.4 days after trauma and was used for 15.5 +/- 1.8 days. The dressing changes were performed in average every 3 days. One patient (8%) with a traumatic hemipelvectomy died in the course of treatment due to septic complications.


CONCLUSIONS
High-energy trauma causing severe soft tissues injuries requires multiple operative debridements to prevent high morbidity and mortality rates. The application of VAC as temporary coverage of large tissue defects in pelvic regions supports wound conditioning and facilitates the definitive wound closure.
Labler
Ludwig
L
Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland. ludwig.labler@usz.ch
Trentz
Otmar
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000673:Amputation, Traumatic / Q000401:mortality / Q000601:surgery; D003646:Debridement; D005260:Female; D005592:Fracture Fixation; D005593:Fracture Fixation, Internal; D005597:Fractures, Open / Q000601:surgery; D006428:Hemipelvectomy; D006801:Humans; D007085:Ilium / Q000293:injuries; D015601:Injury Severity Score; D007869:Leg Injuries / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality / Q000601:surgery*; D054843:Negative-Pressure Wound Therapy; D010384:Pelvic Bones / Q000293:injuries; D010388:Pelvis / Q000293:injuries*; D010502:Perineum / Q000293:injuries / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012446:Sacroiliac Joint / Q000293:injuries; D017695:Soft Tissue Injuries / Q000401:mortality / Q000601:surgery*; D014193:Trauma Centers