Delayed Soft Tissue Coverage after Negative Pressure Wound Therapy in Open Fractures of Lower Extremities

Ki-Chul Park; Hong-Sik Kim; Jeong-Han Oh; Seung-Suk Choi

doi:10.4055/jkoa.2012.47.2.125

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Park, Kim, Oh, and Choi: Delayed Soft Tissue Coverage after Negative Pressure Wound Therapy in Open Fractures of Lower Extremities

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2012; 47(2): 125-132.

Published online: 30 April 2012

DOI: https://doi.org/10.4055/jkoa.2012.47.2.125

Delayed Soft Tissue Coverage after Negative Pressure Wound Therapy in Open Fractures of Lower Extremities

Ki-Chul Park, M.D., Hong-Sik Kim, M.D., Jeong-Han Oh, M.D., Seung-Suk Choi, M.D.^*

Department of Orthopedic Surgery, Guri Hospital, Hanyang University College of Medicine, Guri, Korea.

^*Department of Plastic Surgery, Guri Hospital, Hanyang University College of Medicine, Guri, Korea.

Correspondence to: Ki-Chul Park, M.D. Department of Orthopedic Surgery, Guri Hospital, Hanyang University College of Medicine, 249-1, Gyomun-dong, Guri 471-701, Korea. TEL: +82-31-560-2317, FAX: +82-31-557-8781, kcpark@hanyang.ac.kr

Received 5 July 2011 Revised 18 September 2011 Accepted 16 January 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the delayed soft tissue coverage after previous negative wound therapy in treating wounds associated with open lower extremity fracture.

Materials and Methods

Between June 2007 and February 2011, delayed soft tissue coverage of open lower extremity fractures after previous use of a negative pressure vacuum device, were performed in 15 consecutive patients. Patients included 13 male and 2 female, and their mean age was 39.0 (7-65) years old. Information on the time from injury to definitive wound coverage, type of coverage, functional result, bone union, and complications such as infection were collected.

Results

The vacuum-assisted closure devices was applied for an average of 29.3 (9-50) days, and the mean time from injury to definitive wound was 36.1 (21-60) days. Skin graft coverage was performed in 5 cases, free flap in 8 cases, and local flap in 3 cases. The mean time to radiographic union was 5.2 (3-8) months and delayed union occurred in 2 cases.

Conclusion

Delayed soft tissue coverage after previous negative wound therapy was considered an alternative treatment method in open lower extremity fractures associated with severe concomitant injury.

Keywords: open fractures, negative pressure wound therapy, delayed soft tissue coverage

Figures and Tables

Figure 1

(A) A 31-year-old man sustained type III-B open tibia shaft fracture combined with both femur and head trauma. The hemodynamic state was unstable. (B) The vacuum-assisted closure system was applied to the open wound after debridement and temporary external fixation which was damaged by controlled surgery. (C) Unreamed tibial nail, femoral nails and plate were applied at two weeks after injury. (D) Anterolateral thigh flap was applied at 36 days after injury. (E) Autogenous iliac bone graft was applied to the bone defect at 2 months after injury to enhance bone healing. (F) The fractures were healed without complication. (G) Clinical photograph shows successful result after 4 months using the anterolateral thigh flap.

Figure 2

A patient with deep wound infection by methicillin-resistant Staphylococcus aureus. (A, B) Photograph and radiograph show extensive soft tissue defect and open comminuted fracture of femur shaft. (C) Severe deep wound infection developed after injury. (D) Repeated debridement and change of vacuum-assisted closure system for approximately 40 days. (E) After the infection subsided, undreamed femoral nail was applied. (F) Photograph shows successful result after 14 days using split-thickness skin graft. (G) The radiographs at 24 weeks after surgery show bridging callus around the fracture site.

Table 1

Patients Characteristics in This Study

M, male; F, female.

Table 2

Clinical Results

ALT, anterolateral thigh; IM, intramedullary; GAS, gastrocnemius; MIPO, minimally invasive percutaneous osteosynthesis; STSG, split thickness skin graft; LD, latissimus dorsi.

Table 3

The Criteria of Functional Results by Klemm and Börner

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