title: Use of vacuum-assisted closure (VAC™) in high-energy complicated perineal injuries: analysis of nine cases.
abstract: Our study reviewed nine patients who were treated with the VAC™ Abdominal Dressing System after suffering pelvic fractures and soft tissue loss after high-energy pelvic trauma. Between March 2008 and August 2009, our clinic treated nine patients with complicated perineal injuries from high-energy pelvic trauma with multiple irrigation and debridement procedures and broad-spectrum antibiotics. Protective ostomies were created for all nine patients. Required interventions were made for associated injuries, and VAC™ application was started. All patients were male, with an average age of 24·3 (range 21-32) years, and a mean injury severity score of 36·4 (range 16-59). Wound diameters ranged from 15 to 30 cm, and wound depths ranged from 5 to 25 cm. The injuries included one traumatic bilateral hemipelvectomy, and three unilateral and two bilateral lower extremity amputations. Intensive care unit length of stay averaged 12 (6-19) days, and average hospital length of stay was 44·12 (31-64) days. Beginning at an average of day 17 (±5·9 days) post-injury, wound cultures detected no bacterial colonisation. One patient died on the sixth day after injury from septic complications. Two patients' wounds were closed by primary closure, and six patients' wounds were closed by split thickness grafts after an average of 31·4 (17-50) days. Optimal treatment of high-energy perineal injuries requires early and extensive debridement and rich irrigation. The application of the VAC™ system as temporary coverage of large complex wounds in the pelvic region enhances wound healing and facilitates an early grafting process.
authors.affiliation: Department of General Surgery, Gulhane Military Medical Academy, Ankara, Etlik, Turkey.
authors.forename: Mustafa Tahir
authors.initials: MT
authors.lastname: Ozer
authors.forename: Ali Kagan
authors.initials: AK
authors.lastname: Coskun
authors.forename: Ismail Hakki
authors.initials: IH
authors.lastname: Ozerhan
authors.forename: Nail
authors.initials: N
authors.lastname: Ersoz
authors.forename: Ramazan
authors.initials: R
authors.lastname: Yildiz
authors.forename: Huseyin
authors.initials: H
authors.lastname: Sinan
authors.forename: Sezai
authors.initials: S
authors.lastname: Demirbas
authors.forename: Orhan
authors.initials: O
authors.lastname: Kozak
authors.forename: Ali Ihsan
authors.initials: AI
authors.lastname: Uzar
authors.forename: Sadettin
authors.initials: S
authors.lastname: Cetiner
mesh_terms: D000328:Adult; D004867:Equipment Design; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma; D054843:Negative-Pressure Wound Therapy / Q000295:instrumentation / Q000706:statistics & numerical data*; D010502:Perineum / Q000293:injuries*; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome; D014945:Wound Healing; D014946:Wound Infection / Q000628:therapy*; D055815:Young Adult