A comparative study between primary vacuum assisted closure vs conventional sterile dressing in treatment of soft tissue injuries associated with severe open fractures of both bones leg

Back ground The Primary objective of this prospective randomised study is to compare the rate of infection, primary wound coverage, hospital stay and healing of soft tissue injury associated with severe open fractures of both bones leg treated with two different standard techniques. Methods Forty patients with Type III open fracture both bones of leg were included in this study. They were divided in two groups of 20 each, Group A (VAC) and Group B (sterile dressing group) .All these patients had undergone wound debridement and external fixation. This wss followed by application of Vacuum Assisted Closure (VAC) for Group A and sterile dressings for group B patients.  The infection rate of these two groups was analysed by clinical signs and symptoms. In this study an improvised technique is used for the VAC. Results The infection rate Group A is very low when compared to group B. The primary wound coverage can be done earlier in group A. The hospital stay is minimum in Group A and wound  healing is also faster in Group A patients when compared to group B. Conclusion This is a simple and low cost method for treating soft tissue injury associated with severe open fractures. It can be done even in peripheral hospitals with low resources.

[1]  Vishal Saxena,et al.  Vacuum-assisted closure: microdeformations of wounds and cell proliferation. , 2004, Plastic and reconstructive surgery.

[2]  M. Marks,et al.  The Use of Vacuum‐Assisted Closure Therapy for the Treatment of Lower‐Extremity Wounds with Exposed Bone , 2001, Plastic and reconstructive surgery.

[3]  T E Philbeck,et al.  The clinical and cost effectiveness of externally applied negative pressure wound therapy in the treatment of wounds in home healthcare Medicare patients. , 1999, Ostomy/wound management.

[4]  J. Sinclair,et al.  Primary free-flap cover of open tibial fractures. , 1997, Injury.

[5]  L. Argenta,et al.  Vacuum‐Assisted Closure: A New Method for Wound Control and Treatment: Animal Studies and Basic Foundation , 1997, Annals of plastic surgery.

[6]  D. Hurwitz,et al.  Comparative Clinical Study of the Sure-Closure Device with Conventional Wound Closure Techniques , 1995, Annals of plastic surgery.

[7]  L. Kinzl,et al.  [Vacuum sealing as treatment of soft tissue damage in open fractures]. , 1993, Der Unfallchirurg.

[8]  A. Abramowitz,et al.  Treatment of open tibial fractures with Ender rods. , 1993, Clinical orthopaedics and related research.

[9]  G. Russell,et al.  Primary or delayed closure for open tibial fractures. , 1990, The Journal of bone and joint surgery. British volume.

[10]  P. Manson,et al.  Acute and Definitive Management of Traumatic Osteocutaneous Defects of the Lower Extremity , 1987, Plastic and reconstructive surgery.

[11]  M. Godina.  Early Microsurgical Reconstruction of Complex Trauma of the Extremities , 1986, Plastic and reconstructive surgery.

[12]  D. N. Williams,et al.  Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. , 1984, The Journal of trauma.

[13]  R. Jones,et al.  Primary versus delayed soft tissue coverage for severe open tibial fractures. A comparison of results. , 1983, Clinical orthopaedics and related research.

[14]  K. Veliskakis.  Primary internal fixation in open fractures of the tibal shaft; the problem of wound healing. , 1959, The Journal of bone and joint surgery. British volume.