Role of VAC Dressing in the Large Open Fracture: A Single Center Prospective Study from Indore

Abstract

Background: As the body's protective skin barrier is breached in open fractures, and the potential of contamination is high, these can lead to significant morbidity. Vacuum-assisted closure (VAC) is the application of the negative pressure in open wounds, and it significantly improves wound healing both at the macro and micro levels. Material and Method: A total of 30 patients (23 males and 7 females with a mean age of 27 years) with large open fractures of long bones who received VAC therapy during the early period of treatment were studied. VAC dressing over wound was done following percutaneous pinning or external fixation. In addition, rates of infection, fracture union, duration of application of VAC, and the association of duration of VAC with the development of complications were evaluated. Results: The mean time between the trauma and the first debridement was 8.20 hours (range, 2–23). The mean duration of VAC application was ten days (range, 3–16). Delayed wound closure was performed in nine patients. In the remaining 21 patients, the mean decrease in the wound dimensions between pre and post-VAC application was found to be 43.06% (range, 20–60%). Conclusion: VAC application increases the patient's comfort by reducing the need for dressing changes, improves blood circulation, accelerates the formation of granulation tissue, reduces the rate of infection from the hospital environment, decreases edema, alleviates the need for secondary interventions, and also decreases wound dimensions. Keywords: wound, open fractures, vacuum-assisted closure, wound healing.

Evaluation of Clinical Outcomes of Negative-Pressure Wound Therapy in Gustilo-Anderson Type IIIA/IIIB Open Fractures of Extremities

“…The mean delay between the occurrence of trauma and the beginning of debridement was 13.76 minutes, with an SD of 11.492 minutes. In contrast, Suman et al [3] reported that the mean period between the trauma and the first debridement was 8.20 hours (range: 2-23).…”

“…This finding was similar to that of Lee et al in Korea [21], who found that the average duration of VAC therapy was 18.4 days (range: 11-29 days). Suman et al [3]. from India reported an average period of VAC application of 10 days (range: 3-16).…”

“…Avoidable complications encountered in orthopedic practice are open fractures. In open fractures, the infection percentage of 16-66% has been reported in various investigations [3][4][5][6][7][8][9][10].…”

A Comparative Study on Efficacy of Negative Pressure Wound Therapy Versus Standard Wound Therapy for Patients With Compound Fractures in a Tertiary Care Hospital

“…It is a fact that severe open fractures were presented with a range of 25-66% infection rate [ 1 - 3 ]. Several determinants are always to be well-thought-out when assessing and treating compound fractures in the extremities, including the patient's condition, fracture type, antimicrobial therapy, wound debridement, site and size of the wound, neurovascular status, and the degree of muscle tear [ 4 , 5 ]. Usually, the Gustilo-Anderson classification model is used to classify the compound fractures [ 6 ].…”