TREATMENT OF SOFT TISSUE INJURIES IN GUSTILO ANDERSON GRADE IIIB OPEN FRACTURES BY VACUUM ASSISTED CLOSURE THERAPY A CASE SERIES

Dr Nirup N. `C, Prof Dr V.Vijay Narasimman Reddy

Abstract


Gustilo Anderson compound grade III B fractures have severe soft tissue contamination along with the exposure of the fracture bones to the surrounding environment. Usually the management protocol for wound or soft tissue contamination include wound debribment followed by regular dressing with antibiotic coverage which would take a prolong duration of time for the control of infection. Our main aim is to find out the importance of Vacuum Assisted Closure (VAC) in contaminated wound management with bone or tendon exposure and if there is any difference between the conventional methods or in Vacuum Assisted Closure methods regarding early control of infection, healing of soft tissue etc. In this prospective study we have recruited 20 cases of Gustilo Anderson compound grade IIIB fractures who came to Sree Balaji Medical College And Hospital, Chennai from January 2015 to December 2018. VAC therapy was given to see the time taken for a healthy granulation tissue to cover the soft tissue injury and followed by split skin grafting was done. We found out that out of 20 cases, 14 cases had a good outcome of SSG which was 90% to 95% of taken up. 6 cases had SSG failure and local flap coverage was done. We came to a conclusion that Vacuum Assisted Closure helps in early formation of granulation tissue compared to the other methods.


Keywords


open fracture, Gustilo Anderson compound grade IIIB fractures, Vacuum Assisted Closure (VAC).

Full Text:

PDF

References


Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop Relat Res. 1983;9:7–25.

Morykwas MJ, Argenta LC, Shelton Brown EI, McGuirl W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Annals of Plastic Surgery. 1997;38:553–62.

Mouës CM, Bemd van den CJ, Heule F, Hovius SE. Comparing conventional gauze therapy to vacuum-assisted closure wound therapy: a prospective randomised trial. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2007;60(6):672–81.

European Wound Management Association (EWMA). Position Document: Topical negative pressure in wound management in wound management. http://www.ewma.org/pdf/may07/ EWMA%20Eng%2007%20 final.pdf (accessed 13 November 2007) 2007.

Mendonca DA, Papini R, Price PE. Negative-pressure wound therapy: a snapshot of evidence. International Wound Journal. 2006;3(4):261–71.

Pham CT, Middleton PF, Maddern GJ. The safety and efficacy of topical negative pressure in non-healing wounds: a systematic review. Journal of Wound Care. 2006;15(6):240–50.

Plikaitis CM, Molnar JA. Subatmospheric pressure wound therapy and the vucuum-assisted closure divice: basic science and current clinical successes. Expert Review of Medical Devices. 2006;3(2):175–84.

Ubbink DT, Westerbos SJ, Nelson EA, Vermeulen H. A systematic review of topical negative pressure therapy for acute and chronic wounds. British Journal of Surgery. 2008;95(6):685–92.

Fleischmann W, Strecker W, Bombelli M, Kinzl L. Vacuum Sealing as Treatment of Soft Tissue Damage in Open Fractures. Unfallchirurg. 1993;96(9):488–92.

Robson MC, Steed DL, Franz MG. Wound healing: biologic features and approaches to maximize healing trajectories. Curr Probl Surg. 2001;38(2):72– 140.

Alonso JE, Lee J, Burgess AR, Browner BD. The management of complex orthopaedic injuries. Surg Clin North Am. 1996;76(4):879–903.

Gustilo RB. Mendoza RM Problems in the management of type 3 open fractures J trauma. 1984; 24:742-746.

Velnar T, Bailey T, Smrkolj V. The Wound Healing Process: an Overview of the Cellular and Molecular Mechanisms. The Journal of International Medical Research. 2009;37(5):1528–1542.

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.

Gogia PP. Physiology of wound healing. In: Clinical wound management. Gogia PP, editor, editor. Thorofare, NJ: Slack Incorporated, 1995, 8-12.

Vacuum assisted wound closure therapy. Sbu alert report no 2011-09-2011-11- 02.

Steve Thomas. An introduction to the use of vacuum assisted closure. 2001. May, Accessed 12 April 2016.

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.

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.

Fleischmann W, Strecker W, Bombelli M, Kinzl L. Vacuum sealing for treatment of soft tissue injury in open fractures, Unfallchirurg. 1993; 96(9):488- 492.

Philbeck TE, Whittington KT, Millsap MH, Briones RB, Wight DG, Schroeder WJ. 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. 1999; 45(11):41-50.


Refbacks

  • There are currently no refbacks.