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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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Abstract:

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].

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