title: Vacuum Assisted Closure- utilization as home based therapy in the management of complex diabetic extremity wounds.
abstract: OBJECTIVE
  Vacuum assisted closure is a reported technique to manage complex wounds. We have utilized this technique by using simple locally available material in the management of our patients on outpatient basis. The objective of this study is to present our experience.
  
  
  METHODS
  This study was conducted from June 2011 to June 2013 at Dow University Hospital and Aga Khan University Hospital, Karachi. There were 38 patients managed with vacuum assisted closure. Mean age was 56±7.8 years. Twenty three patients presented with necrotizing fasciitis and 15 patients with gangrene. Lower limbs were involved in majority of the patients. Debridement or amputations were done. Vacuum dressing was changed twice weekly in outpatient department. Wounds were closed secondarily if possible or covered with split thickness skin graft in another admission.
  
  
  RESULTS
  All the wounds were successfully granulated at the end of vacuum therapy. Mean hospital stay was 7.5 days. Vacuum dressing was applied for a mean of 20 days. There was reduction in the size of the wound. Thirteen patients underwent secondary closure of the wound under local anesthesia, 18 patients required coverage with split thickness skin graft and 7 patients healed with secondary intention.
  
  
  CONCLUSIONS
  Vacuum assisted closure appeared to be an effective method to manage complex diabetic wounds requiring sterile wound environment.
authors: Dr. Kamran Hafeez, FCPS, Assistant Professor Orthopedics, Dow International Medical College, Dow University of Health Sciences, Ojha Campus Suparco Road, Karachi, Pakistan.
authors: Kamran
authors: K
authors: Hafeez
authors: Dr. Haroon-ur-Rashid, FCPS, Assistant Professor Orthopedics, Aga Khan University Hospital, Stadium Road, Karachi, Pakistan.
authors: Haroon-Ur-Rashid
authors: Dr. Ghulam Mustafa Kaim Khani, FCPS, Associate Professor Orthopedics, Dow International Medical College, Dow University of Health Sciences, Ojha Campus Suparco Road, Karachi, Pakistan.
authors: Ghulam Mustafa
authors: GM
authors: Kaim Khani
authors: Dr. Darshan Kumar, FCPS, Assistant Professor Medicine, Dow International Medical College, Dow University of Health Sciences, Ojha Campus Suparco Road, Karachi, Pakistan.
authors: Darshan
authors: D
authors: Kumar
authors: Dr. Sunil Kumar, FCPS, Assistant Professor Orthopedics, Dow International Medical College, Dow University of Health Sciences, Ojha Campus Suparco Road, Karachi, Pakistan.
authors: Sunil
authors: S
authors: Kumar
keywords: Complex lower limb wounds; Diabetic wound; Vacuum assisted closure