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Vacuum Assisted Closure Therapy versus Standard Wound Therapy for Open Musculoskeletal Injuries

DOI: 10.1155/2013/245940

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Background. This study was performed to evaluate the results of vacuum assisted wound therapy in patients with open musculoskeletal injuries. Study Design and Setting. Prospective, randomized, and interventional at tertiary care hospital, from 2011 to 2012. Materials and Methods. 30 patients of open musculoskeletal injuries underwent randomized trial of vacuum assisted closure therapy versus standard wound therapy around the upper limb and lower limb. Mean patient age was years (range, 18 to 76 years). Necrotic tissues were debrided before applying VAC therapy. Dressings were changed every 3 or 4 days. For standard wound therapy, debridement followed by daily dressings was done. Data Management and Statistical Analysis. The results obtained were subjected to statistical analysis. Results. The size of soft tissue defects reduced more than 5?mm to 25?mm after VAC (mean decrease of 26.66%), whereas in standard wound therapy, reduction in wound size was less than 5?mm. A free flap was needed to cover exposed bone and tendon in one case in standard wound therapy group. No major complication occurred that was directly attributable to treatment. Conclusion. Vacuum assisted wound therapy was found to facilitate the rapid formation of healthy granulation tissue on open wounds in the upper limb and lower limb, thus to shorten healing time and minimize secondary soft tissue defect coverage procedures. 1. Introduction Wound healing is a complex and dynamic process that includes an immediate sequence of cell migration leading to repair and closure. This sequence begins with removal of debris, control of infection, clearance of inflammation, angiogenesis, deposition of granulation tissue, contraction, remodelling of the connective tissue matrix, and maturation. When wound fails to undergo this sequence of events, a chronic open wound without anatomical or functional integrity results [1]. High-energy open fractures require both skeletal stability and adequate soft tissue coverage. In such injuries, debridement of all nonviable tissue can produce significant soft-tissue defects precluding healing through primary closures, delayed primary closures, or secondary intention [2]. Various surgical methods have been developed to obtain coverage in these difficult situations. These include skin grafts, local rotation flaps, and myocutaneous or fasciocutaneous tissue transfers. Although skin grafts are readily obtainable, they are dependent on the vascularity of its recipient bed and may be contraindicated when exposed bone, cartilage, tendons, or surgical implants exist [3].


[1]  E. Joseph, C. A. Hamori, S. Bergman, E. Roaf, N. F. Swann, and G. W. Anastasi, “A prospective randomized trial of vacuum-assisted closure versus standard therapy of chronic nonhealing wounds,” Wounds, vol. 12, no. 3, pp. 60–67, 2000.
[2]  M. J. Yaremchuk, “Concepts in soft tissue management,” in Lower Extremity Salvage and Reconstruction. Orthopaedic and Plastic Surgical Management, M. J. Yaremchuk, A. R. Burgess, and R. J. Brumback, Eds., pp. 95–106, Elsevier Science, New York, NY, USA, 1989.
[3]  J. A. Haller and R. E. Billingham, “Studies of the origin of the vasculature in free skin grafts,” Annals of Surgery, vol. 166, no. 6, pp. 896–901, 1967.
[4]  M. Geishauser, R. W. Staudenmaier, and E. Biemer, “Donor-site morbidity of the segmental rectus abdominis muscle flap,” British Journal of Plastic Surgery, vol. 51, no. 8, pp. 603–607, 1998.
[5]  M. B. Kelly and A. Searle, “Improving the donor site cosmesis of the latissimus dorsi flap,” Annals of Plastic Surgery, vol. 41, no. 6, pp. 629–632, 1998.
[6]  M. C. Y. Heng, “Topical hyperbaric therapy for problem skin wounds,” Journal of Dermatologic Surgery and Oncology, vol. 19, no. 8, pp. 784–793, 1993.
[7]  M. J. Morykwas and L. C. Argenta, “Vacuum-assisted closure: a new method for wound control and treatment: clinical experience,” Annals of Plastic Surgery, vol. 38, no. 6, pp. 563–577, 1997.
[8]  R. A. F. Clarke and P. M. Henson, Eds., The Molecular and Cellular Biology of Wound Repair, Plenum Press, New York, NY, USA, 1988.
[9]  I. K. Cohen, R. F. Diegelmann, and W. J. Lindblad, Wound Healing: Biochemical and Clinical Aspects, WB Saunders, Philadelphia, Pa, USA, 1992.
[10]  T. K. Hunt, “Vascular factors govern healing in chronic wounds,” in Clinical and Experimental Approach to Dermal and Epidermal Repair: Normal and Chronic Wounds, A. Barbul, M. D. Caldwell, W. H. Eaglstein et al., Eds., pp. 1–17, Wiley & Leiss, New York, NY, USA, 1991.
[11]  G. F. Pierce, J. Vande Berg, R. Rudolph, J. Tarpley, and T. A. Mustoe, “Platelet-derived growth factor-BB and transforming growth factor beta1 selectively modulate glycosaminoglycans, collagen, and myofibroblasts in excisional wounds,” American Journal of Pathology, vol. 138, no. 3, pp. 629–646, 1991.
[12]  M. Laiho and O. J. Keski, “Growth factors in the regulation of pericellular proteolysis: a review,” Cancer Research, vol. 49, no. 10, pp. 2533–2553, 1989.
[13]  M. Laiho and O. J. Keski, “Growth factors in the regulation of pericellular proteolysis: a review,” Cancer Research, vol. 49, no. 10, pp. 2533–2553, 1989.
[14]  D. J. Whitby and M. W. J. Ferguson, “Immunohistological studies of the extracellular matrix and soluble growth factors in fetal and adult wound healing,” in Fetal Wound Healing, N. S. Adzick and M. T. Longaker, Eds., pp. 161–177, Elsevier Science, New York, NY, USA, 1992.
[15]  T. K. Hunt, “The physiology of wound healing,” Annals of Emergency Medicine, vol. 17, no. 12, pp. 1265–1273, 1988.
[16]  J. O. Kucan, M. C. Robson, and J. P. Heggers, “Comparison of silver sulfadiazine, povidone-iodine and physiologic saline in the treatment of chronic pressure ulcers,” Journal of the American Geriatrics Society, vol. 29, no. 5, pp. 232–235, 1981.
[17]  W. O. Seiler, H. B. Stahelin, and W. Sonabend, “Einflus aerobe und anaerober keime auf den heilungsverlauf von dekubitalulzera,” Schweizerische Medizinische Wochenschrift, vol. 109, pp. 1595–1599, 1979.
[18]  D. C. Daltrey, B. Rhodes, and J. G. Chattwood, “Investigation into the microbial flora of healing and non-healing decubitus ulcers,” Journal of Clinical Pathology, vol. 34, no. 7, pp. 701–705, 1981.
[19]  T. J. Ryan, “Microcirculation in psoriasis: blood vessels, lymphatics and tissue fluid,” Pharmacology and Therapeutics, vol. 10, no. 1, pp. 27–64, 1980.
[20]  P. Banwell, S. Withey, and I. Holten, “The use of negative pressure to promote healing,” British Journal of Plastic Surgery, vol. 51, no. 1, pp. 79–82, 1998.
[21]  M. J. Morykwas, L. C. Argenta, E. I. Shelton-Brown, and W. McGuirt, “Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation,” Annals of Plastic Surgery, vol. 38, no. 6, pp. 553–562, 1997.
[22]  T. Weed, C. Ratliff, D. B. Drake et al., “Quantifying bacterial bioburden during negative pressure wound therapy: does the wound VAC enhance bacterial clearance?” Annals of Plastic Surgery, vol. 52, no. 3, pp. 276–280, 2004.
[23]  R. Thoma, “Ueber die histomechanik des gefasssystems und die pathogens der angioskeleroose,” Virchows Archiv für Pathologische Anatomie und Physiologie und für Klinische Medizin, vol. 204, no. 1, pp. 1–74, 1911.
[24]  T. E. Philbeck, K. T. Whittington, M. H. Millsap, R. B. Briones, D. G. Wight, and W. J. Schroeder, “The clinical and cost effectiveness of externally applied negative pressure wound therapy in the treatment of wounds in home healthcare Medicare patients,” Ostomy/Wound Management, vol. 45, no. 11, pp. 41–50, 1999.
[25]  G. A. Ilizarov, “The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation,” Clinical Orthopaedics and Related Research, no. 238, pp. 249–281, 1989.
[26]  G. D. Hall, C. W. Van Way, F. T. K. Fei' Tau Kung, and M. Compton-Allen, “Peripheral nerve elongation with tissue expansion techniques,” Journal of Trauma, vol. 34, no. 3, pp. 401–405, 1993.
[27]  O. M. Alvarez, P. M. Mertz, and W. H. Eaglstein, “The effect of occlusive dressings on collagen synthesis and re-epithelialization in superficial wounds,” Journal of Surgical Research, vol. 35, no. 2, pp. 142–148, 1983.
[28]  A. L. Akin Yoola, A. K. Ako-Nai, O. Dosumu, A. O. Aboderin, and O. O. Kassim, “Microbial isolates in early swabs of open musculoskeletal injuries,” The Nigerian Oostgraduate Medical Journal, vol. 13, no. 3, pp. 176–181, 2006.
[29]  W. Fleischmann, W. Strecker, M. Bombelli, and L. Kinzl, “Vacuum sealing for treatment of soft tissue injury in open fractures,” Unfallchirurg, vol. 96, no. 9, pp. 488–492, 1993.
[30]  S. M. Jones, P. E. Banwell, and P. G. Shakespeare, “Advances in wound healing: topical negative pressure therapy,” Postgraduate Medical Journal, vol. 81, no. 956, pp. 353–357, 2005.


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