Use of vacuum-assisted closure (VAC (TM)) 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.
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ABSTRACT: The case of successful treatment of posttrau-matic rectovaginal fistula with negative pressure therapy is presented. The female, 49 y.o., was admitted to the hospital due to symptoms of general infection that occurred more than three days after the trauma of perineal region. Phys-ical examination revealed a total tear of rectum and anus and rectovaginal fascia defect. Hartmann's procedure was not effective in the management of major exsudation from the perineal wound, that was responsible for hypoproteinemia resulting in fluid in abdominal and pleu-ral cavities. A successful attempt was made to perform secondary closure of rectovaginal fistula and the rectum with support of negative pressure therapy. The repairment of anal sphincters was left for later proceeding. The general patient condition did not improved as well as we would expect and two months after admission patient was moved to the thoracic surgery department due to recurring res-piratory problems.
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ABSTRACT: Blast injuries, caused by explosions accompanied by high-pressure waves, produce tissue damage in the acute period, followed in the later period by circulatory disorders due to vascular endothelial damage and related tissue necrosis. Blunt rectal perforation is rare and difficult to diagnose. In the acute period following blast pelvic injuries, the main objectives are to stop bleeding, minimise contamination and preserve the patient's life. The patient in this report had major vascular injuries, severe pelvic injury and, in the later period, rectal perforation because of vascular endothelial damage caused by the blast effect. Our aim was to treat the patient conservatively because of his poor general condition. We placed a self-expanding covered stent (SECS) into the rectum and then applied negative pressure wound therapy (NPWT; V.A.C.(®) Therapy, KCI) to the pelvic region and perirectal area. At the end of the treatment, the rectal perforation was closed, and the patient was discharged with healing. In this article, we discuss the novel use of an SECS with NPWT and review related literature.International Wound Journal 06/2014; 11 Suppl 1(s1):25-9. DOI:10.1111/iwj.12287 · 2.15 Impact Factor