A Clinical Study of Vacuum Assisted Closure of Open Wounds in Orthopaedics

Abstract

Background: The management of difficult to heal wounds has always been a cause of concern for the treating orthopeadicians. There has been a tremendous increase in the number patients presenting with difficult to heal wounds. Aims: to study the functional outcome of open wounds in orthopaedics by VAC therapy. Infection rate, time taken for secondary closure or split skin grafting studied. Materials and methods: It is prospective study in Seventeen patients with open wounds collected over a period of two and a half years. Gustilo Anderson Compound Grade 2,3a,3b type fractures, Acute traumatic soft tissue injuries without bone involvement and Post operative infected wounds with implant in-situ were included in study.Results:. The age group 30-50 dominates the series accounting for 44% among the cases. Open compound fractures caused by road traffic accidents includes 14 cases (82.35%), train traffic accident 2 cases(11.76%) and accidental fall 1 case(5.88%). Mean wound size reduction at treatment completion 15mm (10-20mm) . 15 patients among the 17 achieved good wound healing and the tendons which were exposed were adequately covered by granulation tissue. The mean duration required for formation of healthy uniform granulation bed was 10.5 days(9-12 days) After VAC therapy, SSG was done to cover the healthy granulation tissue in 13 patients and flap cover was done for 4 patients. Conclusions: VAC therapy has wide range of benefits it can be applied to most of the wounds but all wounds cannot be treated by VAC therapy. VAC causes bone exposed wound to be covered by granulation tissue which requires a simple split skin graft to cover the granulation tissue where as the bone exposed area needs a more time consuming and more expertized flap cover for covering the wound.