title: Use of vacuum-assisted closure and a dermal regeneration template as an alternative to flap reconstruction in pediatric grade IIIB open lower-extremity injuries.
abstract: Severe degloving injuries to the pediatric lower extremity are difficult to treat, traditionally requiring local or free flaps for coverage. Combining vacuum-assisted closure techniques with a dermal regeneration template is proposed as a means for covering these difficult wounds. We retrospectively reviewed the charts of 7 consecutive patients (age range, 2-12 years) who underwent this treatment. All extremities healed without flap reconstruction or amputation. Mean follow-up was 24.4 months, and mean wound size was 196 cm2. There were 2 superficial graft complications, 1 nonunion successfully treated with bone grafting, 2 patients with subsequent bony deformity, and 1 patient who underwent subsequent soft-tissue procedures for equinus contracture. Use of vacuum-assisted closure and a dermal regeneration template has shown good results as a means of successfully managing grade IIIB injuries without performing complicated flap reconstructions.
authors: Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1070, USA. tbarnett@wfubmc.edu
authors: Ted M
authors: TM
authors: Barnett
authors: Jeffrey S
authors: JS
authors: Shilt
mesh_terms: D002648:Child; D002675:Child, Preschool; D002809:Chondroitin Sulfates; D003094:Collagen; D005500:Follow-Up Studies; D017102:Fracture Healing; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000295:instrumentation / Q000379:methods; D017768:Skin, Artificial; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome
chemical_list: C114835:integra artificial skin; D002809:Chondroitin Sulfates; D003094:Collagen