Advanced wound therapies in the management of severe military lower limb trauma: a new perspective

S L A Jeffery, S L A Jeffery

Abstract

Objective: The purpose of this article is to describe the treatment of injuries resulting from land mine explosions using a holistic approach that includes gauze-based negative pressure wound therapy (NPWT) and encompasses wound bed preparation, exudate management, and infection control.

Method: In the treatment of 3 traumatic injuries, each requiring limb amputation, we describe the application of NPWT using the Chariker-Jeter system, which uses a single layer of saline-moistened antimicrobial gauze laid directly onto the wound bed. A silicone drain is placed on the gauze and then more gauze is placed over the drain to fill the wound. This is then covered with a clear semipermeable film, cut so that there is a 2- to 3-cm border around the wound allowing it to be sealed onto healthy skin.

Results: In each of the cases described, we were able to achieve wound closure prior to successful skin grafting, and the patients have recovered well despite the severity of their injuries.

Conclusion: We discuss the potential advantages of the Chariker-Jeter system over polyurethane foam as a method of delivering NPWT in highly extensive and irregular-shaped wounds created by land mine explosions while stressing the importance of thorough and effective wound bed preparation.

Figures

Figure 1
Figure 1
Land mine injury.
Figure 2
Figure 2
Debridement using the VERSAJET hydrosurgey system.
Figure 3
Figure 3
Coverage using a rotation flap.
Figure 4
Figure 4
Soldier postsurgery.
Figure 5
Figure 5
Pressure plate improvised explosive device injury.
Figure 6
Figure 6
Site of wound after debridement, application of negative pressure wound therapy, and skin grafting.
Figure 7
Figure 7
Amputated limb postdebridement.
Figure 8
Figure 8
Treatment with gauze-based negative pressure wound therapy over wound area.
Figure 9
Figure 9
Amputation stump post–skin grafting, following 10 days' negative pressure wound therapy.
Figure 10
Figure 10
A typical wound shape resulting from an explosive device.
Figure 11
Figure 11
Gauze packed within a typical wound shape.
Figure 12
Figure 12
Shape of wound more suitable for sponge.
Figure 13
Figure 13
Foam placed in an irregular wound shape.
Figure 14
Figure 14
Foam under pressure in an irregular wound shape.

References

    1. Kanakaris NK, Thanasas C, Keramaris N, Kontakis G, Granick M, Giannoudis P. The efficacy of negative pressure wound therapy in the management of lower extremity trauma: review of clinical evidence. Injury. 2007;38(S5):S9–18.
    1. Chariker M, Jeter K, Tintle T, Bottsford J. Effective management of incisional and cutaneous fistulae with closed suction wound drainage. Contemp Surg. 1989;34:59–63.
    1. Timmons J. The use of the Versatile-1 wound vacuum system to treat a patient with a challenging grade 3 pressure ulcer in continuing care. Wounds. 2006;2:125.
    1. Hunter J, Teot L, Horch R, Banwell P. Evidence-based medicine: vacuum-assisted closure in wound care management. Int Wound J. 2007;4:256–69.
    1. Miller M, Ortegon M, MacDaniel C. Negative pressure wound therapy: treating a venomous insect bite. Int Wound J. 2007;4:88–92.
    1. Malmsjö M, Ingemansson R, Martin R, Huddleston Negative pressure wound therapy using gauze or polyurethane open cell foam: similar early effects on pressure transduction and tissue contraction in an experimental porcine wound model. Wound Repair Regen. 2009;17:200–5.
    1. Malmsjö M, Ingemansson R, Martin R, Huddleston E. Paper presented at: World Union of Wound Healing Societies. Toronto, Canada: Smith & Nephew data on file; 2008. Negative pressure wound therapy using gauze or polyurethane open cell foam: similar effects on wound edge microvascular blood flow.
    1. Campbell P, Smith G, Smith J. Retrospective clinical evaluation of gauze-based negative pressure wound therapy. Int Wound J. 2008;5:280–6.
    1. Argenta L, Morykwas M, Marks M, DeFranzo A, Molnar J, David L. Vacuum-assisted closure: state of clinic art. Plast Reconstr Surg. 2006;117(7S):127S–42S.
    1. Kaufman M, Pahl D. Vacuum-assisted closure therapy: wound care and nursing implications. Dermatol Nurs. 2003;4:317–25.
    1. Bickels J, Kollender Y, Wittig J, Cohen N, Meller I, Malawer M. Vacuum-assisted wound closure after resection of musculoskeletal tumors. Clin Orthop Relat Res. 2005;441:346–50.
    1. Shirakawa M, Isseroff R. Topical negative pressure devices. Arch Dermatol. 2005;141(11):1449–53.
    1. Venturi M, Attinger C, Mesbahi A, Hess C, Graw K. Mechanisms and clinical applications of the vacuum-assisted closure (VAC) device: a review. Am J Clin Dermatol. 2005;6(3):185–94.
    1. Campbell P. Surgical wound case studies with the Versatile 1 wound vacuum system for negative pressure wound therapy. J Wound Ostomy Continence Nurs. 2006;33:2–10.
    1. Pikaitis C, Molnar J. Subatmospheric pressure wound therapy and the vacuum-assisted closure device: basic science and current clinical successes. Exp Rev Med Dev. 2006;3(2):175–84.
    1. Woodfield J, Parry B, Bissett I, McKee M. Experience with the use of vacuum dressings in the management of acute enterocutaneous fistulas. ANZ J Surg. 2006;76(12):1085–7.
    1. Miller M, McDaniel C. Treating wound dehiscence with an alternative system of delivering topical negative pressure. J Wound Care. 2006;15(7):321–4.

Source: PubMed

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