Vacuum-assisted closure downgrades reconstructive demands in high-risk patients with severe lower extremity injuries.
BACKGROUND
Primary soft tissue reconstruction in complex leg injuries is mandatory in order to protect exposed tissues; however, it may be precluded by the patient's clinical status or by local wound conditions. This retrospective study aims to evaluate the use of negative pressure as an adjunct to delayed soft tissue reconstruction in patients with complex lower limb trauma.


METHODS
Forty-two patients with 49 complex lower limb injuries were treated with Vacuum assisted closure (VAC) 48 hours after bone fixation, vascular repair and surgical debridement. Wound swab cultures were obtained before and after every VAC application. Duration of therapy, wound flora, final reconstructive technique required, outcome and follow-up period were retrieved from medical records.


RESULTS
Twenty-four male and eighteen female patients were recruited, with a mean age of 47 years. All were treated with VAC therapy for 15-42 days. Reconstruction was delayed due to the patients' critical condition, advanced age, medical co-morbidities, heavily exuding wounds and questionable viability of soft tissues. Patients were followed up for 90-895 days. Two wounds healed spontaneously, 6 were managed with delayed direct suture, 31 with split thickness skin grafts and 9 required local cutaneous, fasciocutaneous or muscular flaps. One patient died due to fat embolism. Wound bacterial flora progressively decreased in all but one patient. Scar formation was aesthetically acceptable by the patients while function depended on the initial injury.


CONCLUSIONS
Negative pressure is a safe and effective adjunct to delayed soft tissue reconstruction in high-risk patients with severe lower extremity injuries, minimizing reconstructive requirements and therefore postoperative morbidity.
Department of Plastic Surgery, Democritus University, Alexandroupolis University Hospital, Dragana, Alexandroupolis, Greece. despoinakakagia@yahoo.com
D
D
Kakagia
E
E
Karadimas
G
G
Drosos
A
A
Ververidis
D
D
Kazakos
M
M
Lazarides
D
D
Verettas
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery; D054843:Negative-Pressure Wound Therapy; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000601:surgery*; D013978:Tibial Fractures / Q000601:surgery; D055815:Young Adult