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Soft Tissue Management in Open Fractures of the Lower Leg: The Role of Vacuum Therapy

  • Focus on Soft Tissue and Bone Reconstruction
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

The management of severe open fractures of the lower leg continues to challenge the treating surgeon. Major difficulties include high infection rates as well as adequate temporary soft tissue coverage. In the past, these injuries were commonly associated with loss of the extremity. Today, vacuum therapy provides not only safe temporary wound coverage but also conditioning of the soft tissues until definitive wound closure. Amongst other advantages, bacterial clearance and increased formation of granulation tissue are attributed to vacuum therapy, making it an extremely attractive tool in the field of wound healing. However, despite its clinical significance, which is underlined by a constantly increasing range of indications, there is a substantial lack of basic research and well-designed studies documenting the superiority of vacuum therapy compared to alternative wound dressings. Vacuum therapy has been approved as an adjunct in the treatment of severe open fractures of the lower leg, complementing repeated surgical debridement and soft tissue coverage by microvascular flaps, which are still crucial in the treatment of these limb-threatening injuries. Vacuum therapy has in general proven useful in the management of soft tissue injuries and, since it is generally well tolerated and has low complication rates, it is fast becoming the gold standard for temporary wound coverage in the treatment of severe open fractures of the lower leg.

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References

  1. Parrett BM, Matros E, Pribaz JJ, Orgill DP. Lower extremity trauma: trends in the management of soft-tissue reconstruction of open tibia-fibula fractures. Plast Reconstr Surg 2006;117:1315–22. Discussion 1323-4.

    Article  PubMed  CAS  Google Scholar 

  2. Labler L, Keel M, Trentz O. Vacuum-assisted closure (VAC) for temporary coverage of soft-tissue injury in type III open fractures of lower extremities. Eur J Trauma 2004;5:305–12.

    Article  Google Scholar 

  3. Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 1984;24:742–6.

    Article  PubMed  CAS  Google Scholar 

  4. Willy C, Voelker H, Engelhardt M. Literature on the subject of vacuum therapy: review and update 2006. Eur J Trauma Emerg Surg 2007;1:33–9.

    Article  Google Scholar 

  5. Venturi ML, Attinger CE, Mesbahi AN, Hess CL, Graw KS. Mechanisms and clinical applications of the vacuum-assisted closure (VAC) device: a review. Am J Clin Dermatol 2005;6:185–94.

    Article  PubMed  Google Scholar 

  6. Fleischmann W, Strecker W, Bombelli M, Kinzl L. Vacuum sealing as treatment of soft tissue damage in open fractures. Unfallchirurg 1993;96:488–92.

    PubMed  CAS  Google Scholar 

  7. Huang J, Yao YZ, Huang XK. Treatment of open fracture by vacuum sealing technique and internal fixation. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2003;17:456–8.

    PubMed  Google Scholar 

  8. Raffel AB. The use of negative pressure under skin flaps after radical mastectomy. Ann Surg 1952;136:1048.

    Article  Google Scholar 

  9. Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 1997;38:563–76. Discussion 577.

    Article  PubMed  CAS  Google Scholar 

  10. Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 1997;38:553–62.

    Article  PubMed  CAS  Google Scholar 

  11. Holle G, Germann G, Sauerbier M, Riedel K, von Gregory H, Pelzer M. Vacuum-assisted closure therapy and wound coverage in soft tissue injury. Clinical use. Unfallchirurg 2007;110:289–300.

    CAS  Google Scholar 

  12. Fleischmann W, Lang E, Kinzl L. Vacuum assisted wound closure after dermatofasciotomy of the lower extremity. Unfallchirurg 1996;99:283–7.

    Article  PubMed  CAS  Google Scholar 

  13. Fleischmann W, Russ M, Marquardt C. Closure of defect wounds by combined vacuum sealing with instrumental skin expansion. Unfallchirurg 1996;99:970–4.

    Article  PubMed  CAS  Google Scholar 

  14. Fleischmann W, Lang E, Russ M. Treatment of infection by vacuum sealing. Unfallchirurg 1997;100:301–4.

    Article  PubMed  CAS  Google Scholar 

  15. Deva AK, Siu C, Nettle WJ. Vacuum-assisted closure of a sacral pressure sore. J Wound Care 1997;6:311–2.

    PubMed  CAS  Google Scholar 

  16. Zutt M, Haas E, Kruger U, Distler M, Neumann C. Successful use of vacuum-assisted closure therapy for leg ulcers caused by occluding vasculopathy and inflammatory vascular diseases — a case series. Dermatology 2007;214:319–24.

    Article  PubMed  Google Scholar 

  17. Korber A, Franckson T, Grabbe S, Dissemond J. Vacuum assisted closure device improves the take of mesh grafts in chronic leg ulcer patients. Dermatology 2008;216:250–6.

    Article  PubMed  CAS  Google Scholar 

  18. Roka J, Karle B, Andel H, Kamolz L, Frey M. Use of V.A.C. Therapy in the surgical treatment of severe burns: the Viennese concept. Handchir Mikrochir Plast Chir 2007;39:322–7.

    Article  PubMed  CAS  Google Scholar 

  19. Hanasono MM, Skoracki RJ. Securing skin grafts to microvascular free flaps using the vacuum-assisted closure (VAC) device. Ann Plast Surg 2007;58:573–6.

    Article  PubMed  CAS  Google Scholar 

  20. Anagnostakos K, Kelm J, Schmitt E. Indications for use of the V.A.C.-system in the orthopedic surgery. Zentralbl Chir 2006;131:S87–92.

    Article  PubMed  Google Scholar 

  21. Cothren CC, Moore EE, Johnson JL, Moore JB, Burch JM. One hundred percent fascial approximation with sequential abdominal closure of the open abdomen. Am J Surg 2006;192:238–42.

    Article  PubMed  Google Scholar 

  22. Dionigi G, Dionigi R, Rovera F, Boni L, Padalino P, Minoja G, Cuffari S, Carrafiello G. Treatment of high output enterocutaneous fistulae associated with large abdominal wall defects: single center experience. Int J Surg 2008;6:51–6.

    Article  PubMed  CAS  Google Scholar 

  23. Labler L, Keel M, Trentz O. New application of V.A.C. (vacuum assisted closure) in the abdominal cavity in case of open abdomen therapy. Zentralbl Chir 2004;129:S14–19.

    PubMed  Google Scholar 

  24. Ditterich D, Rexer M, Rupprecht H. Vacuum assisted would closure technique in bronchial stump dehiscence after lobectomy — a case report from thoracic surgery. Zentralbl Chir 2004;129:S137.

    Article  PubMed  Google Scholar 

  25. Sumpio BE, Banes AJ. Response of porcine aortic smooth muscle cells to cyclic tensional deformation in culture. J Surg Res 1988;44:696–701.

    Article  PubMed  CAS  Google Scholar 

  26. Sadoshima J, Izumo S. Mechanical stretch rapidly activates multiple signal transduction pathways in cardiac myocytes: potential involvement of an autocrine/paracrine mechanism. Embo J 1993;12:1681–92.

    PubMed  CAS  Google Scholar 

  27. Olenius M, Dalsgaard CJ, Wickman M. Mitotic activity in expanded human skin. Plast Reconstr Surg 1993;91:213–6.

    Article  PubMed  CAS  Google Scholar 

  28. Saxena V, Hwang CW, Huang S, Eichbaum Q, Ingber D, Orgill DP. Vacuum-assisted closure: microdeformations of wounds and cell proliferation. Plast Reconstr Surg 2004;114:1086–96. Discussion 1097–1098.

    Article  PubMed  Google Scholar 

  29. Holzheimer RG, Steinmetz W. Local and systemic concentrations of pro- and anti-inflammatory cytokines in human wounds. Eur J Med Res 2000;5:347–55.

    PubMed  CAS  Google Scholar 

  30. Labler L, Mica L, Harter L, Trentz O, Keel M. Influence of V.A.C.-therapy on cytokines and growth factors in traumatic wounds. Zentralbl Chir 2006;131:S62–7.

    Article  PubMed  Google Scholar 

  31. Labler L, Rancan M, Mica L, Harter L, Mihic D, Keel M. Vacuumassisted closure (VAC) therapy increases local interleukin-8 and vascular endothelial growth factor levels in traumatic wounds. J Trauma 2008; in press.

  32. Shi B, Chen SZ, Zhang P, Li JQ. Effects of vacuum-assisted closure (VAC) on the expressions of MMP-1, 2, 13 in human granulation wound. Zhonghua Zheng Xing Wai Ke Za Zhi 2003;19:279–81.

    PubMed  CAS  Google Scholar 

  33. Robson MC, Stenberg BD, Heggers JP. Wound healing alterations caused by infection. Clin Plast Surg 1990;17:485–92.

    PubMed  CAS  Google Scholar 

  34. McCallon SK, Knight CA, Valiulus JP, Cunningham MW, McCulloch JM, Farinas LP. Vacuum-assisted closure versus saline-moistened gauze in the healing of postoperative diabetic foot wounds. Ostomy Wound Manage 2000;46:28-32, 34.

    Google Scholar 

  35. Eginton MT, Brown KR, Seabrook GR, Towne JB, Cambria RA. A prospective randomized evaluation of negative-pressure wound dressings for diabetic foot wounds. Ann Vasc Surg 2003;17:645–9.

    Article  PubMed  Google Scholar 

  36. Schneider AM, Morykwas MJ, Argenta LC. A new and reliable method of securing skin grafts to the difficult recipient bed. Plast Reconstr Surg 1998;102:1195–8.

    Article  PubMed  CAS  Google Scholar 

  37. Gwan-Nulla DN, Casal RS. Toxic shock syndrome associated with the use of the vacuum-assisted closure device. Ann Plast Surg 2001;47:552–4.

    Article  PubMed  CAS  Google Scholar 

  38. Khatod M, Botte MJ, Hoyt DB, Meyer RS, Smith JM, Akeson WH. Outcomes in open tibia fractures: relationship between delay in treatment and infection. J Trauma 2003;55:949–54.

    Article  PubMed  Google Scholar 

  39. Dickson K, Katzman S, Delgado E, Contreras D. Delayed unions and nonunions of open tibial fractures. Correlation with arteriography results. Clin Orthop Relat Res 1994;302:189–93.

    PubMed  Google Scholar 

  40. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 1976;58:453–8.

    PubMed  CAS  Google Scholar 

  41. DeFranzo AJ, Argenta LC, Marks MW, Molnar JA, David LR, Webb LX, Ward WG, Teasdale RG. The use of vacuum-assisted closure therapy for the treatment of lower-extremity wound with exposed bone. Plast Reconstr Surg 2001;108:1184–91.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Triemli Hospital, Zurich, Switzerland

    Mario Rancan MD

  2. Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, Zurich, Switzerland

    Mario Rancan MD

  3. Department of Orthopaedic Surgery, Inselspital Bern, Bern, Switzerland

    Marius Keel

  4. Centre for Clinical Research, University of Zurich, Zurich, Switzerland

    Marius Keel

  5. Department of Surgery, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zurich, Switzerland

    Mario Rancan MD

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  1. Mario Rancan MD
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  2. Marius Keel
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Correspondence to Mario Rancan MD.

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Rancan, M., Keel, M. Soft Tissue Management in Open Fractures of the Lower Leg: The Role of Vacuum Therapy. Eur J Trauma Emerg Surg 35, 10–16 (2009). https://doi.org/10.1007/s00068-008-8215-5

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  • DOI: https://doi.org/10.1007/s00068-008-8215-5

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