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Acute complex traumas of the lower limbs: a modern reconstructive approach with negative pressure therapy
Author(s) -
Bollero Daniele,
Carnino Riccardo,
Risso Daniela,
Gangemi Ezio N.,
Stella Maurizio
Publication year - 2007
Publication title -
wound repair and regeneration
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.847
H-Index - 109
eISSN - 1524-475X
pISSN - 1067-1927
DOI - 10.1111/j.1524-475x.2007.00267.x
Subject(s) - medicine , surgery , granulation tissue , negative pressure wound therapy , debridement (dental) , fixation (population genetics) , concomitant , external fixation , wound healing , external fixator , population , alternative medicine , environmental health , pathology
Acute traumas of the lower limbs cause complex functional damage for the association of skin loss with exposed tendons, bones, and/or vessels, requiring a multidisciplinary approach. Once bone fixation and vascular repair have been carried out, the surgical treatment for skin damage is usually based on early coverage with conventional or microsurgical flaps. Negative pressure therapy can play a primary role in the management of the elderly or intensive care patients, where wounds are secondary to life‐threatening problems. A total of 35 patients with 37 acute traumatic wounds of the lower limbs were treated with vacuum‐assisted closure (VAC ® ) therapy for an average of 22 days (range 3–46 days). The sponge was applied the day after bone fixation, vascular repair, and surgical debridement of nonviable tissues, so as to obtain a better control of bleeding. After VAC ® treatment, all patients quickly developed healthy granulation tissue and a significant reduction in both extent and depth of wounds. Split‐thickness skin grafts were used to cover granulation tissue in most of the cases (66%—24 cases), and then local flaps (13%—five cases) or direct sutures (8%—three cases). The wounds healed spontaneously without surgical management in four patients. One patient died during the treatment period for concomitant diseases. No relevant complications directly related to VAC ® therapy were observed other than one case of severe pain in an amputated stump. The average follow‐up duration was 265 days (range 33–874 days). No further tegumentary reconstruction was required. VAC ® therapy may represent a valid alternative to immediate reconstruction in selected cases of acute complex traumas of the lower limb and allows for a stable functional result, using a minimally invasive approach.