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

Kushagra Sinha, Vijendra D Chauhan, Rajesh Maheshwari, Neena Chauhan, Manu Rajan, Atul Agrawal, Kushagra Sinha, Vijendra D Chauhan, Rajesh Maheshwari, Neena Chauhan, Manu Rajan, Atul Agrawal

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 39 ± 18 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.

Figures

Figure 1
Figure 1
Foam was cut according to wound size.
Figure 2
Figure 2
Sterile drape was applied covering the foam and 2-3 cm of the surrounding skin.
Figure 3
Figure 3
The connecting tube was applied after making a small opening (3-4 mm) on the drape.
Figure 4
Figure 4
The connecting tube was connected to the negative pressure wound therapy.
Figure 5
Figure 5
(a) Day 0: wound size, 146 × 135 mm. (b) Day 0: photomicrograph number 1-H and E stained section (100x) shows: dense neutrophilic exudates on the surface of wound. (c) Day 4: wound size, 130 × 120 mm. (d) Day 4: photomicrograph number 2-H and E stained section (100x) shows: fibrinous exhudate on the surface and base of ulcer is formed by moderately inflamed granulation tissue. (e) Day 8: wound size, 130 × 117 mm. (f) Day 8: photomicrograph number 3-H and E stained section (100x) shows: many newly formed blood vessels and dense fibro collagenous tissue. (g) SSG uptake seen.
Figure 6
Figure 6
(a) Day 0: wound size, 146 × 61 mm. (b) Day 0: photomicrograph number 1-H and E stained section (100x) shows: thick neutrophillic exhudate on the surface and skeletal muscle bundles. (c) Day 4: wound size, 141 × 51 mm. (d) Day 4: photomicrograph number 2-H and E stained section (100x) shows: Inflammed granulation tissue with little exhudate on the surface. (e) Day 8: Wound size, 135 × 51 mm. (f) Day 8: photomicrograph number 3-H and E stained section (100x) shows: healthy granulation tissue without any exhudate. (g) Secondary closure done.

References

    1. Joseph E, Hamori CA, Bergman S, Roaf E, Swann NF, Anastasi GW. A prospective randomized trial of vacuum-assisted closure versus standard therapy of chronic nonhealing wounds. Wounds. 2000;12(3):60–67.
    1. Yaremchuk MJ. Concepts in soft tissue management. In: Yaremchuk MJ, Burgess AR, Brumback RJ, editors. Lower Extremity Salvage and Reconstruction. Orthopaedic and Plastic Surgical Management. New York, NY, USA: Elsevier Science; 1989. pp. 95–106.
    1. Haller JA, Billingham RE. Studies of the origin of the vasculature in free skin grafts. Annals of Surgery. 1967;166(6):896–901.
    1. Geishauser M, Staudenmaier RW, Biemer E. Donor-site morbidity of the segmental rectus abdominis muscle flap. British Journal of Plastic Surgery. 1998;51(8):603–607.
    1. Kelly MB, Searle A. Improving the donor site cosmesis of the latissimus dorsi flap. Annals of Plastic Surgery. 1998;41(6):629–632.
    1. Heng MCY. Topical hyperbaric therapy for problem skin wounds. Journal of Dermatologic Surgery and Oncology. 1993;19(8):784–793.
    1. Morykwas MJ, Argenta LC. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Annals of Plastic Surgery. 1997;38(6):563–577.
    1. Clarke RAF, Henson PM, editors. The Molecular and Cellular Biology of Wound Repair. New York, NY, USA: Plenum Press; 1988.
    1. Cohen IK, Diegelmann RF, Lindblad WJ. Wound Healing: Biochemical and Clinical Aspects. Philadelphia, Pa, USA: WB Saunders; 1992.
    1. Hunt TK. Vascular factors govern healing in chronic wounds. In: Barbul A, Caldwell MD, Eaglstein WH, et al., editors. Clinical and Experimental Approach to Dermal and Epidermal Repair: Normal and Chronic Wounds. New York, NY, USA: Wiley & Leiss; 1991. pp. 1–17.
    1. Pierce GF, Vande Berg J, Rudolph R, Tarpley J, Mustoe TA. Platelet-derived growth factor-BB and transforming growth factor beta1 selectively modulate glycosaminoglycans, collagen, and myofibroblasts in excisional wounds. American Journal of Pathology. 1991;138(3):629–646.
    1. Laiho M, Keski OJ. Growth factors in the regulation of pericellular proteolysis: a review. Cancer Research. 1989;49(10):2533–2553.
    1. Laiho M, Keski OJ. Growth factors in the regulation of pericellular proteolysis: a review. Cancer Research. 1989;49(10):2533–2553.
    1. Whitby DJ, Ferguson MWJ. Immunohistological studies of the extracellular matrix and soluble growth factors in fetal and adult wound healing. In: Adzick NS, Longaker MT, editors. Fetal Wound Healing. New York, NY, USA: Elsevier Science; 1992. pp. 161–177.
    1. Hunt TK. The physiology of wound healing. Annals of Emergency Medicine. 1988;17(12):1265–1273.
    1. Kucan JO, Robson MC, Heggers JP. Comparison of silver sulfadiazine, povidone-iodine and physiologic saline in the treatment of chronic pressure ulcers. Journal of the American Geriatrics Society. 1981;29(5):232–235.
    1. Seiler WO, Stahelin HB, Sonabend W. Einflus aerobe und anaerober keime auf den heilungsverlauf von dekubitalulzera. Schweizerische Medizinische Wochenschrift. 1979;109:1595–1599.
    1. Daltrey DC, Rhodes B, Chattwood JG. Investigation into the microbial flora of healing and non-healing decubitus ulcers. Journal of Clinical Pathology. 1981;34(7):701–705.
    1. Ryan TJ. Microcirculation in psoriasis: blood vessels, lymphatics and tissue fluid. Pharmacology and Therapeutics. 1980;10(1):27–64.
    1. Banwell P, Withey S, Holten I. The use of negative pressure to promote healing. British Journal of Plastic Surgery. 1998;51(1):79–82.
    1. Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Annals of Plastic Surgery. 1997;38(6):553–562.
    1. Weed T, Ratliff C, Drake DB, et al. Quantifying bacterial bioburden during negative pressure wound therapy: does the wound VAC enhance bacterial clearance? Annals of Plastic Surgery. 2004;52(3):276–280.
    1. Thoma R. Ueber die histomechanik des gefasssystems und die pathogens der angioskeleroose. Virchows Archiv für Pathologische Anatomie und Physiologie und für Klinische Medizin. 1911;204(1):1–74.
    1. 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.
    1. Ilizarov GA. 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. 1989;(238):249–281.
    1. Hall GD, Van Way CW, Fei’ Tau Kung FTK, Compton-Allen M. Peripheral nerve elongation with tissue expansion techniques. Journal of Trauma. 1993;34(3):401–405.
    1. Alvarez OM, Mertz PM, Eaglstein WH. The effect of occlusive dressings on collagen synthesis and re-epithelialization in superficial wounds. Journal of Surgical Research. 1983;35(2):142–148.
    1. Akin Yoola AL, Ako-Nai AK, Dosumu O, Aboderin AO, Kassim OO. Microbial isolates in early swabs of open musculoskeletal injuries. The Nigerian Oostgraduate Medical Journal. 2006;13(3):176–181.
    1. 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.
    1. Jones SM, Banwell PE, Shakespeare PG. Advances in wound healing: topical negative pressure therapy. Postgraduate Medical Journal. 2005;81(956):353–357.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe