Comparison of vacuum assisted closure (VAC) and standard therapy in compound fractures

Abstract

Background: A bone fracture is a medical condition where the continuity of the bone is broken. Open fractures usually are high-energy injuries. This, along with the exposure of bone and deep tissue to the environment, leads to increased risk of infection, wound complications, and non-union [1,2] . Antibiotics, surgical debridement, and internal fixation have improved outcomes of open fracture management in important ways, and it includes primary asepsis, adequate debridement, immobilization, and protection of wounds against disturbance and reinfection [3,4] . Wound healing is a complex and dynamic process that includes an immediate sequence of cell migration leading to repair and closure. This sequence begins with removal of debris, control of infection, clearance of inflammation, angiogenesis, deposition of granulation tissue, contraction, remodeling of the connective tissue matrix and maturation. When wound fails to undergo this sequence of events, a chronic open wound without anatomical or functional integrity results. Vacuum assisted closure (VAC) is relatively a new technique which hastens granulation tissue formation by speeding up all these parameters [5] . Materials and Methods: The present study was Hospital based Prospective comparative study carried out from July 2016 to October 2018, on 90 cases satisfying the inclusion criteria following complete assessment. Patients were assessed by efficacy of both procedures was measured by the time taken by wound be optimal for skin grafting/flap, whether slough and discharge present or not, rate of decrease in size of wound (%) and whether flap is needed or avoided by use of VAC dressing Result: Both group are compare on the basis of type of fracture as per Gustillo and Anderson classification, duration of receiving treatment from initial injury, slough was comparable on day 0 and day 4, frequency of discharge, granulation tissue and size of wound. Conclusion: VAC therapy show final cessation of slow earlier than those treated by standard therapy for fracture management. VAC therapy shows earlier control of discharge, earlier appearance granulation tissue and earlier decrease in size of wound compare to standard therapy. Rate of healing is faster in VAC therapy compared to standard therapy. Earlier optimized covering of wound can be obtained by VAC therapy. Requirement of skin grafting is less in subjects treated with VAC therapy. Minimal complications with complete healing possible with VAC therapy in compound fractures of lower limb.