title: Sequential therapy of vacuum sealing drainage and free-flap transplantation for children with extensive soft-tissue defects below the knee in the extremities.
abstract: OBJECTIVE
  The aim of the study is to evaluate the surgical technique and clinical significance of the sequential therapy of vacuum sealing drainage (VSD) and free-flap transplantation for children with extensive soft-tissue defects below the knee in the extremities.
  
  
  METHODS
  Twenty-two children (aged from 3 to 10 years) received sequential therapy of VSD and free-flap transplantation. All cases suffered from extensive area soft-tissue defects and exposure or partial defects of bones, tendons and other deep tissues. The wound sizes varied from 10 cm × 6 cm to 30 cm × 22 cm. Amongst 22 cases, 12 cases had fresh wounds and the remaining 10 children had necrotising infection. After complete debridement, the wounds were covered by VSD. External fixation or Kirschner-wire fixation should be performed for the cases complicated by unsteady fractures. After the removal of negative pressure VSD devices, free-flap transplantations were performed in 8 cases after debridement, and 14 cases received combined therapy of free-flap transplantation and skin grafting depending upon the severity of soft-tissue and deep-tissue defects. The flap survival and wound healing were followed up postoperatively.
  
  
  RESULTS
  After VSD treatment, the infection of deep-tissue exposure was effectively prevented, and granulation tissues surrounding the exposed areas of tendons and bones grew well. All patients who received free-flap transplantation at the second stage survived without the occurrence of vascular crisis, infection or sinus formation. During follow-up ranging from 6 to 24 months, all the patients were satisfied with the morphological appearance and functional recovery of the affected limbs.
  
  
  CONCLUSIONS
  Sequential therapy of VSD and free-flap transplantation can serve as a reliable option for children with extensive soft-tissue defects below the knee in the extremities and exposed deep tissues, after complete debridement, which significantly shortens remedy period, enhances success rate for surgery and achieves maximal restoration of limb function.
authors.affiliation: Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China.
authors.forename: Run-Guang
authors.initials: RG
authors.lastname: Li
authors.forename: Bin
authors.initials: B
authors.lastname: Yu
authors.forename: Gang
authors.initials: G
authors.lastname: Wang
authors.forename: Bin
authors.initials: B
authors.lastname: Chen
authors.forename: Cheng-He
authors.initials: CH
authors.lastname: Qin
authors.forename: Gang
authors.initials: G
authors.lastname: Guo
authors.forename: Dan
authors.initials: D
authors.lastname: Jin
authors.forename: Gao-Hong
authors.initials: GH
authors.lastname: Ren
mesh_terms: D000063:Accidents, Traffic; D002648:Child; D002675:Child, Preschool; D003646:Debridement; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006801:Humans; D007869:Leg Injuries / Q000503:physiopathology / Q000601:surgery*; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D020127:Recovery of Function; D017695:Soft Tissue Injuries / Q000503:physiopathology / Q000601:surgery*; D014618:Vacuum; D014945:Wound Healing; D014946:Wound Infection / Q000517:prevention & control / Q000601:surgery*