Subatmospheric pressure dressing as a bridge to free tissue transfer in the treatment of open tibia fractures

Division of Plastic Surgery, University of Kentucky, Lexington, Ky. 40536-0284, USA.
Plastic and Reconstructive Surgery (Impact Factor: 2.99). 05/2008; 121(5):1664-73. DOI: 10.1097/PRS.0b013e31816a8d9d
Source: PubMed


Free flap reconstruction performed shortly after injury is associated with reduced complications but is not always feasible. Subatmospheric pressure dressings have several beneficial effects on wounds. This study reviewed a large series of open tibia fractures to determine whether subatmospheric pressure dressings affected complication rates.
One hundred five patients underwent free muscle flap reconstruction for open tibia fractures between 1991 and 2005. Patients were divided into three groups: acute (flap performed 1 to 7 days after injury), subacute (8 to 42 days after injury), and chronic (>42 days after injury). Five outcome measures were used: infectious complications, flap-related complications, surgical procedures, hospital stay, and time to bony union. The subacute group was divided into patients who underwent subatmospheric pressure dressing therapy and those who did not.
The complication rate in the subacute group (n = 55) was 47 percent, compared with 39 percent in the chronic group (n = 18) and 31 percent in the acute group (n = 32). Time to union was significantly shorter in the acute group than in the other groups. Subacute patients who underwent subatmospheric dressing therapy had lower overall complication (35 percent), infectious complication (6 percent), and flap-related complication rates (12 percent) than those who did not (53, 18, and 21 percent, respectively). Time to union was significantly shorter with the dressings.
Subatmospheric pressure dressing therapy as a "bridge" to free flap reconstruction in patients with open tibia fractures was associated with reduced complication rates in the subacute group, suggesting that the dressings may effectively extend the acute period when early free tissue transfer is not possible.

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    • "Rinket et al. [37] completed a retrospective review of 111 open tibia fractures treated with free flaps. They focused on the effect of NPWT in patients who had definitive flap reconstruction performed ‘sub acutely’ (between 8-42 days). "
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    ABSTRACT: Negative pressure wound therapy is a popular treatment for the management of both acute and chronic wounds. Its use in trauma and orthopedics is diverse and includes the acute traumatic setting as well as chronic troublesome wounds associated with pressure sores and diabetic foot surgery. Efforts have been made to provide an evidence base to guide its use however this has been limited by a lack of good quality evidence. The following review article explores the available evidence and describes future developments for its use in trauma and orthopaedic practice.
    The Open Orthopaedics Journal 06/2014; 8(1):168-77. DOI:10.2174/1874325001408010168
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    • "Vacuum-assisted closure was used for 2 weeks before coverage of the wound with a latissimus dorsi myocutaneous free flap was performed. Even though flap coverage during the first week of treatment has shown decreased complication rates such as flap failure and infection, Rinker et al. [10] showed that using a subatmospheric dressing could bring down the complication rates of flap coverage within 6 weeks similarly to that performed in the acute stage. Following this procedure allowed us more time to observe the wound for any further necroses that would have necessitated debridement. "
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    ABSTRACT: We present a case of a near total amputation at the distal tibial level, in which the patient emphatically wanted to save the leg. The anterior and posterior tibial nerves were intact, indicating a high possibility of sensory recovery after revascularization. The patient had open fractures at the tibia and fibula, but no bone shortening was performed. The posterior tibial vessels were reconstructed with an interposition saphenous vein graft from the contralateral side and a usable anterior tibial artery graft from the undamaged ipsilateral distal portions. The skin and soft tissue defects were covered using a subatmospheric pressure system for demarcating the wound, and a latissimus dorsi myocutaneous free flap for definite coverage of the wound. At 6 months after surgery, the patient was ambulatory without requiring additional procedures. Replantation without bone shortening, with use of vessel grafts and temporary coverage of the wound with subatmospheric pressure dressings before definite coverage, can shorten recovery time.
    Archives of Plastic Surgery 07/2012; 39(4):417-21. DOI:10.5999/aps.2012.39.4.417
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    ABSTRACT: Management of lower limb wounds can present challenge to reconstructive surgeon if options for reconstruction are limited. The situation worsens when such patients have co-morbidities like trauma to vital organs, diabetes mellitus, and generalized disorders which impair wound healing. Negative pressure wound therapy has gained popularity in the management of wounds in the last decade. We have used a modified form of commercially available V.A.CTM because of its high cost and universal unavailability. Fifty-eight patients with 61 complex wounds of the lower limb were included in the study over a period of 3years. The average number of dressing changes was 3.2 and average duration from start of therapy till the wound was ready for coverage was 13.5days. Fifty-seven wounds were skin grafted and four wounds were covered with local turnover flaps. We have found the modified vacuum dressing to be an effective technique for treating challenging wounds of the lower limb when options for reconstruction are limited. KeywordsNegative pressure wound therapy–Lower extremity reconstruction–Complex wounds–Vacuum-assisted closure
    European Journal of Plastic Surgery 01/2011; 34(3):161-166. DOI:10.1007/s00238-010-0485-6
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