Archives of Orthopaedic and Trauma Surgery

, Volume 131, Issue 2, pp 255–259 | Cite as

The clinical efficacy of the vacuum-assisted closure therapy in the management of adult osteomyelitis

  • Y. Tan
  • X. Wang
  • H. Li
  • Q. Zheng
  • J. Li
  • G. Feng
  • Zhijun PanEmail author
Orthopaedic Outcome Assessment



Vacuum-assisted closure (VAC) therapy is a sophisticated development of a standard surgical procedure. The purpose of this study is to evaluate the clinical efficacy of managing adult osteomyelitis with VAC therapy.

Materials and methods

We included a total of 68 patients that developed osteomyelitis with Cierny–Mader types 2, 3 and 4, and required open wound management between March 2005 and February 2009. In this study, 35 of these patients were treated by VAC therapy and the other 33 by conventional wound management. The patients were well compared with type, debridement times, wounds coverage, bacteriology and recurrence.


Of the study, the patients treated by VAC therapy had a significantly reduced recurrence (1 vs. 7 wounds, P < 0.05), decreased rate of further autodermoplasty or flap surgery (17 vs. 26 wounds, P < 0.05), and increased cases of bacterial species cultures to negative (29 vs. 15 wounds, P < 0.05), debridement times and type were similar between the two groups.


VAC therapy represents a good clinical efficacy in treating osteomyelitis; it can promote the granulation tissue formation, bacterial clearance, and reduce the needs for tissue transfer and muscle flaps in patients. In addition, it could be used as an adjuvant for the eradication of osteomyelitis and improving soft-tissue management, it may be more suitable for treating osteomyelitis with soft-tissue problems.


Vacuum-assisted closure Osteomyelitis Debridement Granulation tissue 



This study was supported by the Medicine Health Sciences Fund of Zhejiang (2008A095) and the Natural Science Foundation of Zhejiang (Y208034, Y2100111).

Conflict of interest

The authors had no conflicts of interest to declare in relation to this article.


  1. 1.
    Archdeacon MT, Messerschmitt P (2006) Modern Papineau technique with vacuum-assisted closure. J Orthop Trauma 20:134–137CrossRefPubMedGoogle Scholar
  2. 2.
    Argenta LC, Morykwas MJ (1997) Vacuum-assisted closure: a new method for wound control and treatment. Clinical experience. Ann Plast Surg 38:563–576CrossRefPubMedGoogle Scholar
  3. 3.
    Argenta LC, Morykwas MJ, Marks MW et al (2006) Vacuum-assisted closure: state of clinic art. Plas Reconstr Surg 117(7 Suppl):S127–S142CrossRefGoogle Scholar
  4. 4.
    Banwell PE (1999) Topical negative pressure therapy in wound care. J Wound Care 8:79–84PubMedGoogle Scholar
  5. 5.
    Braakenburg A, Obdeijn MC, Feitz R et al (2006) The clinical efficacy and cost effectiveness of the vacuum-assisted closure technique in the management of acute and chronic wounds: a randomized controlled trial. Plast Reconstr Surg 118:390–397CrossRefPubMedGoogle Scholar
  6. 6.
    Canavese F, Gupta S, Krajbich JI et al (2008) Vacuum-assisted closure for deep infection after spinal instrumentation for scoliosis. J Bone Joint Surg Br 90:377–381CrossRefPubMedGoogle Scholar
  7. 7.
    Chen SZ, Cao DY, Li JQ et al (2005) Effect of vacuum-assisted closure on the expression of proto-oncogenes and its significance during wound healing. Zhonghua Zheng Xing Wai Ke Za Zhi 21:197–200PubMedGoogle Scholar
  8. 8.
    Dedmond BT, Kortesis B, Punger K et al (2006) Subatmospheric pressure dressings in the temporary treatment of soft-tissue injuries associated with type III open tibial shaft fractures in children. J Pediatr Orthop 26:728–732PubMedGoogle Scholar
  9. 9.
    DeFranzo AJ, Argenta LC, Marks MW et al (2001) The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone. Plast Reconstr Surg 108:1184–1191CrossRefPubMedGoogle Scholar
  10. 10.
    Fleischmann W, Strecker W, Bombelli M et al (1993) Vacuum sealing as treatment of soft-tissue damage in open fractures. Unfallchirurg 96:488–492PubMedGoogle Scholar
  11. 11.
    Gustilo RB, Anderson JT (1976) 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) 58A:453–458Google Scholar
  12. 12.
    Haas DW, McAndrew MP (1996) Bacterial osteomyelitis in adults: evolving considerations in diagnosis and treatment. Am J Med 101:550–561CrossRefPubMedGoogle Scholar
  13. 13.
    Hanasono MM, Skoracki RJ (2007) Securing skin grafts to microvascular freeflaps using the vacuum-assisted closure (VAC) device. Ann Plast Surg; 58:573–576CrossRefPubMedGoogle Scholar
  14. 14.
    Herscovici DJ, Sanders RW, Scaduto JM et al (2003) Vacuum-assisted wound closure (VAC therapy) for the management of patients with high-energy soft-tissue injuries. J Orthop Trauma 17:683–688CrossRefPubMedGoogle Scholar
  15. 15.
    Joseph E, Hamori CA, Bergman S et al (2000) A prospective randomized trial of vacuum-assisted closure versus standard therapy of chronic non-healing wounds. Wounds 12:60–67Google Scholar
  16. 16.
    Leininger BE, Rasmussen TE, Smith DL et al (2006) Experience with wound VAC and delayed primary closure of contaminated soft-tissue injuries in Iraq. J Trauma 61:1207–1211CrossRefPubMedGoogle Scholar
  17. 17.
    Mader JT, Calhoun J (1994) Long bone osteomyelitis: diagnosis and management. Hosp Prac 29:71–76Google Scholar
  18. 18.
    McCallon SK, Knight CA, Valiulus JP et al (2000) Vacuum-assisted closure versus saline-moistened gauze in the healing of post-operative diabetic foot wounds. Ostomy Wound Manage 46:28–32PubMedGoogle Scholar
  19. 19.
    Mullner T, Mrkonjic L, Kwasny O et al (1997) The use of negative pressure to promote healing of tissue defects: a clinical trial using the vacuum sealing technique. Br J Plast Surg 50:194–199CrossRefPubMedGoogle Scholar
  20. 20.
    Morykwas MJ, Simpson J, Punger K et al (2006) Vacuum-assisted closure: state of basic research and physiologic foundation. Plast Reconstr Surg 117(7 Suppl):S121–S126CrossRefGoogle Scholar
  21. 21.
    Mouës CM, Vos MC, van den Bemd GJ et al (2004) Bacterial load in relation to vacuum-assisted closure wound therapy: a prospective randomized trial. Wound Repair Regen 12:11–17CrossRefPubMedGoogle Scholar
  22. 22.
    Pape HC, Webb LX (2008) History of open wound and fracture treatment. J Orthop Trauma 22(10 Suppl):S133–S134CrossRefPubMedGoogle Scholar
  23. 23.
    Powell ET 4th (2008) The role of negative pressure wound therapy with reticulated open cell foam in the treatment of war wounds. J Orthop Trauma 22(10 Suppl):S138–S141CrossRefPubMedGoogle Scholar
  24. 24.
    Trampuz A, Zimmerli W (2006) Diagnosis and treatment of infections associated with fracture-fixation devices. Injury 37(Supp l2):S59–S66CrossRefPubMedGoogle Scholar
  25. 25.
    Tsukayama DT (1999) Pathophysiology of posttraumatic osteomyelitis. Clin Orthop Relat Res 360:22–29CrossRefPubMedGoogle Scholar
  26. 26.
    Saxena V, Hwang CW, Huang S et al (2004) Vacuum-assisted closure: microdeformations of wounds and cell proliferation. Plast Reconst Surg 114:1086–1096CrossRefPubMedGoogle Scholar
  27. 27.
    Webb LX, Dedmond B, Schlatterer D et al (2006) The contaminated highenergy open fracture: a protocol to prevent and treat inflammatory mediator storm-induced soft-tissue compartment syndrome (IMSICS). J Am Acad Orthop Surg 14(Suppl):S82–S86PubMedGoogle Scholar
  28. 28.
    Webb LX, Laver D, DeFranzo A (2004) Negative pressure wound therapy in the management of orthopedic wounds. Ostomy Wound Manage 50(4A Suppl):S26–S27Google Scholar
  29. 29.
    Zimmerli W, Trampuz A, Ochsner PE (2004) Prosthetic-joint infections. N Engl J Med 351(16):1645–1654CrossRefPubMedGoogle Scholar
  30. 30.
    Ziran H (2007) Osteomyelitis. J Trauma 62(6 Suppl):S59–S60CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Y. Tan
    • 1
  • X. Wang
    • 1
  • H. Li
    • 1
  • Q. Zheng
    • 1
  • J. Li
    • 1
  • G. Feng
    • 1
  • Zhijun Pan
    • 1
    Email author
  1. 1.Department of Orthopaedic Surgery, The Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina

Personalised recommendations