Use of vacuum-assisted closure (VAC™) in high-energy complicated perineal injuries: analysis of nine cases

Abstract

Our study reviewed nine patients who were treated with the VAC™ Abdominal Dressing System after suffering pelvic fractures and soft tissue loss after high-energy pelvic trauma. Between March 2008 and August 2009, our clinic treated nine patients with complicated perineal injuries from high-energy pelvic trauma with multiple irrigation and debridement procedures and broad-spectrum antibiotics. Protective ostomies were created for all nine patients. Required interventions were made for associated injuries, and VAC™ application was started. All patients were male, with an average age of 24·3 (range 21-32) years, and a mean injury severity score of 36·4 (range 16-59). Wound diameters ranged from 15 to 30 cm, and wound depths ranged from 5 to 25 cm. The injuries included one traumatic bilateral hemipelvectomy, and three unilateral and two bilateral lower extremity amputations. Intensive care unit length of stay averaged 12 (6-19) days, and average hospital length of stay was 44·12 (31-64) days. Beginning at an average of day 17 (±5·9 days) post-injury, wound cultures detected no bacterial colonisation. One patient died on the sixth day after injury from septic complications. Two patients' wounds were closed by primary closure, and six patients' wounds were closed by split thickness grafts after an average of 31·4 (17-50) days. Optimal treatment of high-energy perineal injuries requires early and extensive debridement and rich irrigation. The application of the VAC™ system as temporary coverage of large complex wounds in the pelvic region enhances wound healing and facilitates an early grafting process.

Use of self‐expanding covered stent and negative pressure wound therapy to manage late rectal perforation after injury from an improvised explosive device: a case report

“…NPWT has been reported to increase the formation of granulation tissue on the wound surface (resulting in improved microperfusion), increase partial oxygen pressure in the tissue and reduce bacterial colonisation . Our earlier study , and also the study by Schaffzin et al , demonstrated that at the end of NPWT, wound care was facilitated and healing was accelerated. These advantages led to earlier wound closure, early skin grafting and earlier hospital discharge .…”

“…A mine explosion causes a blast wave or ‘blast overpressure’, which is a sudden increase in air pressure over normal atmospheric pressure . Acute traumatic injuries are expected as a result of the blast effect of explosions; however, late visceral injuries and necrosis may also occur as a result of vascular endothelial injuries . Blast injuries cause decreased microcirculation, which can result in a great deal of necrosis.…”

Modified Classification and Repair of Perineal Soft Tissue Injuries Associated with Open Pelvic Fractures

“…In recent years, negative pressure wound closure systems have been widely used for injuries in the perineal region. [5][6][7][8][9][10] The clinical application of NPWT with the VSD has proved to be a very efficient closure technique for our patients.…”

“…In contrast, early radical debridement and provisional negative pressure wound therapy (NPWT) coverage is widely acknowledged as a reliable approach for the protection of large perineal wounds to prevent infection, stimulate granulation tissue formation, and reduce the area requiring flap coverage, thus improving the success of any subsequent surgery and reducing postoperative complications. [8][9][10] A reliable and clinically relevant classification system for open pelvic fracture is of great importance for clinical care and future research. Such a system provides an effective means of combining similar injuries, distinguishing patterns, and stratifying injury severity.…”

Damage Control Surgery and Management of Open Abdomen

“…nötrofil akümülasyonuna ve anjiogenesise neden olacak olan IL-8 ve vasküler endotelyal büyüme faktörü- nün lokal artışını sağlar (23,24) . Enfeksiyon nedeniyle o bölgede oluşan enflamatuvar sitokinlerin, proteolitik enzimlerin de sistemik dolaşıma katılmadan ortamdan uzaklaştırılmasını sağlaması da üstün diğer bir özelliğidir (25)(26)(27)(28) .…”