Subatmospheric pressure dressings in the temporary treatment of soft tissue injuries associated with type III open tibial shaft fractures in children.
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.
Dedmond
Barnaby T
BT
Department of Lexington Orthopaedics, 110 East Medical Lane, Suites 220 & 235, West Columbia, SC 29169, USA. dedmoba@yahoo.com
Kortesis
Bill
B
Punger
Kathleen
K
Simpson
Jordan
J
Argenta
Joseph
J
Kulp
Brenda
B
Morykwas
Michael
M
Webb
Lawrence X
LX
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