Download PDF
CC BY-NC-ND 4.0 · Indian J Plast Surg 2020; 53(01): 097-104
DOI: 10.1055/s-0039-3400192
Original Article

Management of Wounds with Exposed Bones or Tendons in Children by Vacuum-Assisted Closure Therapy: A Prospective Study

Altaf Rasool
1   Department of Plastic Surgery, Sher-i- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
,
Sheikh Adil Bashir
1   Department of Plastic Surgery, Sher-i- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
,
Prince Ajaz Ahmad
2   Department of Surgery, Sher-i- Kashmir Institute of Medical Sciences Srinagar, Kashmir, India
,
Akram Hussain Bijli
1   Department of Plastic Surgery, Sher-i- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
,
Umer Farooq Baba
1   Department of Plastic Surgery, Sher-i- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
,
Mir Yasir
1   Department of Plastic Surgery, Sher-i- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
,
Adil Hafeez Wani
1   Department of Plastic Surgery, Sher-i- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
› Author Affiliations Financial Support and Sponsorship Nil.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background The management of complex soft tissue defects with exposed bones/tendons is always a challenging task for the surgeon and the problem becomes more pronounced when it comes to the management of these wounds in children. Though flap procedures are considered the standard for managing the complex soft tissue defects with exposed bones/tendons yet small blood vessels for anastomosis, long operative period, increased chances of perioperative thrombosis, and difficult perioperative management in children add to the difficulty in performing flap procedures in children. The vacuum-assisted closure (VAC) therapy has emerged as a novel modality for the management of the difficult wounds with added advantages, especially in children.

Objective To evaluate the efficacy of VAC in the management of wounds with exposed bones/tendons in children.

Patients and Method Forty-six children of complex wounds with exposed bones/tendons were included in the study from July 2016 to June 2018.

Results Out of 46 patients, 31 were male; the patients had a mean age of 8.4 years. Road traffic accident was the most common mode of injury (54%), with most of the wounds located over extremities. The mean duration of VAC therapy was 12 days. More than 90% coverage of the exposed structure was seen in 89% of patients. The wounds were definitively managed by split-thickness skin graft in 89% of patients and flap cover in 6.5% of patients. The mean cost of the VAC therapy at our government run hospital was 187 Indian rupees per day. No significant major complications were seen during the treatment.

Conclusion VAC therapy is an efficient, safe, and cost-effective modality of treatment for the management of complex wounds in the pediatric population.

Keywords

vaccum-assisted closure - VAC - exposed bone - exposed tendon


Publication History

Article published online:
06 April 2020

© .

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Chariker ME, Gerstle TL, Morrison CS. An algorithmic approach to the use of gauze-based negative-pressure wound therapy as a bridge to closure in pediatric extremity trauma. Plast Reconstr Surg 2009; 123 (05) 1510-1520
    CrossrefPubMedGoogle Scholar
  • 2 Fenn CH, Butler PE. Abdominoplasty wound-healing complications: assisted closure using foam suction dressing. Br J Plast Surg 2001; 54 (04) 348-351
    CrossrefPubMedGoogle Scholar
  • 3 Banwell PE, Téot L. Topical negative pressure (TNP): the evolution of a novel wound therapy. J Wound Care 2003; 12 (01) 22-28
    CrossrefPubMedGoogle Scholar
  • 4 Orgill DP, Manders EK, Sumpio BE, Lee RC, Attinger CE. Mechanism of action of vacuum assisted closure: more to learn. J Surg 2009; 146: 40-51
    Google Scholar
  • 5 Wiegand C, White R. Microdeformation in wound healing. Wound Repair Regen 2013; 21 (06) 793-799
    CrossrefPubMedGoogle Scholar
  • 6 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. Ann Plast Surg 1997; 38 (06) 553-562
    CrossrefPubMedGoogle Scholar
  • 7 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. Clin Orthop Relat Res 1989; (238) 249-281
    PubMedGoogle Scholar
  • 8 Mooney III JF, Argenta LC, Marks MW, Morykwas MJ, DeFranzo AJ. Treatment of soft tissue defects in pediatric patients using the V.A.C. system. Clin Orthop Relat Res 2000; (376) 26-31
    PubMedGoogle Scholar
  • 9 DeFranzo AJL, Argenta LC, Marks MW. et al. The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone. Plast Reconstr Surg 2001; 108 (05) 1184-1191
    CrossrefPubMedGoogle Scholar
  • 10 Mullner T, Mrkonjic L, Kwasny O, Vecsie V. The use of negative pressure to promote the healing of tissue defects: a clinical trial using the vacuum sealing technique. Br J Plast Surg 1997; 50: 194-199
    CrossrefPubMedGoogle Scholar
  • 11 DeFranzo AJ, Marks MW, Argenta LC, Genecov DG. Vacuum-assisted closure for the treatment of degloving injuries. Plast Reconstr Surg 1999; 104 (07) 2145-2148
    CrossrefPubMedGoogle Scholar
  • 12 Helgeson MD, Potter BK, Evans KN, Shawen SB. Bioartificial dermal substitute: a preliminary report on its use for the management of complex combat-related soft tissue wounds. J Orthop Trauma 2007; 21 (06) 394-399
    CrossrefPubMedGoogle Scholar
  • 13 Repta R, Ford R, Hoberman L, Rechner B. The use of negative-pressure therapy and skin grafting in the treatment of soft-tissue defects over the Achilles tendon. Ann Plast Surg 2005; 55 (04) 367-370
    CrossrefPubMedGoogle Scholar
  • 14 Eltayeb H, Kassem R. Negative pressure wound therapy in pediatric extremity trauma: a single-institute experience. Egypt J Surg 2017; 36: 260-264
    CrossrefGoogle Scholar
  • 15 Lee HJ, Kim JW, Oh CW. et al. Negative pressure wound therapy for soft tissue injuries around the foot and ankle. J Orthop Surg Res 2009; 4: 14
    CrossrefPubMedGoogle Scholar
  • 16 Dedmond BT, Kortesis B, Punger K. et al. Subatmospheric pressure dressings in the temporary treatment of soft tissue injuries associated with type III open tibial shaft fractures in children. J Pediatr Orthop 2006; 26: 728-732
    CrossrefPubMedGoogle Scholar
  • 17 Kang GC, Por YC, Tan BK. In vivo tissue engineering over wounds with exposed bone and tendon: autologous dermal grafting and vacuum-assisted closure. Ann Plast Surg 2010; 65 (01) 70-73
    CrossrefPubMedGoogle Scholar
  • 18 Baharestani MM. Use of negative pressure wound therapy in the treatment of neonatal and pediatric wounds: a retrospective examination of clinical outcomes. Ostomy Wound Manage 2007; 53 (06) 75-85
    PubMedGoogle Scholar
  • 19 Caniano DA, Ruth B, Teich S. Wound management with vacuum-assisted closure: experience in 51 pediatric patients. J Pediatr Surg 2005; 40 (01) 128-132
    CrossrefPubMedGoogle Scholar
  • 20 Bütter A, Emran M, Al-Jazaeri A. Ouimet A. Vacuum-assisted closure for wound management in the pediatric population. J Pediatr Surg 2006; 41 (05) 940-942
    CrossrefPubMedGoogle Scholar
  • 21 Kolios L, Kolios G, Beyersdorff M. et al. Cost analysis of topical negative pressure (TNP) therapy for traumatic acquired wounds. Ger Med Sci 2010; 8: Doc13
    PubMedGoogle Scholar
  • 22 Chaput B, Garrido I, Eburdery H, Grolleau JL, Chavoin JP. Low-cost negative-pressure wound therapy using wall vacuum: a 15 dollar by day alternative. Plast Reconstr Surg Glob Open 2015; 3 (06) e418
    CrossrefPubMedGoogle Scholar
  • 23 Braakenburg A, Obdeijn MC, Feitz R. van Rooij IA, van Griethuysen AJ, Klinkenbijl JH. The clinical efficacy and cost effectiveness of the vacuum-assisted closure technique in the management of acute and chronic wounds: a randomized controlled trial. Plast Reconstr Surg 2006; 118 (02) 390-397
    CrossrefPubMedGoogle Scholar
  • 24 Mouës CM, van den Bemd GJ, Meerding WJ, Hovius SE. An economic evaluation of the use of TNP on full-thickness wounds. J Wound Care 2005; 14 (05) 224-227
    CrossrefPubMedGoogle Scholar