title: Subatmospheric pressure dressings in the temporary treatment of soft tissue injuries associated with type III open tibial shaft fractures in children.
abstract: OBJECTIVE
  This study was designed to evaluate the use of subatmospheric pressure dressings on high-energy open tibial shaft fractures in children. We hypothesized that the use of a negative-pressure dressing in these fractures would result in a decreased incidence of infection and decreased need for pedicled muscle flaps and free tissue transfer.
  
  
  METHODS
  A retrospective case series of 15 consecutive pediatric patients with 16 type III open tibial shaft fractures (8 type IIIA, 7 type IIIB, and 1 type IIIC). The patients' age ranged from 2 to 17 years. All patients underwent a standard protocol of serial irrigation and debridement of the open wound with bony stabilization. Temporary coverage of the open wound was obtained with the use of a subatmospheric pressure dressing until definitive wound coverage or closure.
  
  
  RESULTS
  Infection occurred in 5 of 16 fractures, 2 requiring antibiotics alone (1 type IIIA and 1 type IIIB) and 3 requiring surgical intervention (2 type IIIB and 1 type IIIC). Seven of 16 (3 type IIIA, 3 type IIIB, and 1 type IIIC) fractures required repeat surgical intervention to facilitate bony healing. Only 3 patients required free tissue transfers or rotational muscle flaps for coverage, a 50% decrease compared with the initial classification.
  
  
  CONCLUSIONS
  Compared with other described methods, the use of subatmospheric pressure dressings in the temporary treatment of soft tissue wounds associated with high-energy open tibial shaft may reduce the need for major soft tissue coverage procedures. Its effect on infection and fracture healing rates requires further study.
  
  
  CONCLUSIONS
  A reduction in the need for major soft tissue coverage procedures with the use of negative-pressure dressings in this setting should result in decreased morbidity for these patients and in decreased social and financial costs.
authors.affiliation: Department of Lexington Orthopaedics, 110 East Medical Lane, Suites 220 & 235, West Columbia, SC 29169, USA. dedmoba@yahoo.com
authors.forename: Barnaby T
authors.initials: BT
authors.lastname: Dedmond
authors.forename: Bill
authors.initials: B
authors.lastname: Kortesis
authors.forename: Kathleen
authors.initials: K
authors.lastname: Punger
authors.forename: Jordan
authors.initials: J
authors.lastname: Simpson
authors.forename: Joseph
authors.initials: J
authors.lastname: Argenta
authors.forename: Brenda
authors.initials: B
authors.lastname: Kulp
authors.forename: Michael
authors.initials: M
authors.lastname: Morykwas
authors.forename: Lawrence X
authors.initials: LX
authors.lastname: Webb
mesh_terms: D000293:Adolescent; D000399:Air Pressure; D001458:Bandages; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005597:Fractures, Open / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000209:etiology / Q000628:therapy*; D013978:Tibial Fractures / Q000150:complications* / Q000175:diagnosis; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014945:Wound Healing; D014946:Wound Infection / Q000517:prevention & control