Abstract
Background:
Bone and soft-tissue defects in infected wound have been an intractable problem to many surgical consultations. Infected wounds with bone defects are physical and financial burden to society. Nowadays, infected wounds with compound defect of bone and soft tissues are common in orthopedics department. Currently, no simple and efficient treatment has been found to solve this problem. This study investigates the effects of combining negative pressure wound therapy (NPWT) with open bone graft on this focus.
Materials and Methods:
Twenty four rabbits with bone and soft tissue defects accompanied infected wounds were randomized into experimental (combined NPWT with open bone graft) and contrast group (only open bone graft). Treatment efficacy was assessed by the wound condition; wound healing time, bacterial bioburden, and bony callus were evaluated by X-ray. Furthermore, samples of granulation tissue from wounds on the 3rd, 7th, and 14th days of healing were evaluated for blood vessels and expression of vascular endothelial growth factor.
Results:
Wounds in the experimental group tended to have shorter healing time, healthier wound conditions, lower bacterial bioburden, better bony callus, and more blood supply than those in the controlled group.
Conclusions:
In conclusion, NPWT combined open bone graft can act as a feasible and valuable method to treat combined infected bone and soft-tissue defects.
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References
Fleischmann W, Strecker W, Bombelli M, Kinzl L. Vacuum sealing as treatment of soft tissue damage in open fractures. Unfallchirurg 1993;96:488–92.
Lei H, Yi L. One-stage open cancellous bone grafting of infected fracture and nonunion. J Orthop Sci 1998;3:318-23.
Arslan E, Ozturk OG, Aksoy A, Polat G. Vacuum-assisted closure therapy leads to an increase in plasma fibronectin level. Int Wound J 2011;8:224–8.
Kadowaki I, Ichinohasama R, Harigae H, Ishizawa K, Okitsu Y, Kameoka J, et al. Accelerated lymphangiogenesis in malignant lymphoma: Possible role of VEGF-A and VEGF-C. Br J Haematol 2005;130:869–77.
Papineau IJ, Alfageme A. Chronic osteomyelitis of long bone resection and bone grafting with delayed skin closure. J Bone Joint Surg (Br), 1976;58:138.
de Laat EH, van den Boogaard MH, Spauwen PH, van Kuppevelt DH, van Goor H, Schoonhoven L. Faster wound healing with topical negative pressure therapy in difficult-to-heal wounds: A prospective randomized controlled trial. Ann Plast Surg 2011;67:626–31.
Armstrong DG, Lavery LA, Abu-Rumman P, Espensen EH, Vazquez JR, Nixon BP, et al. Outcomes of subatmospheric pressure dressing therapy on wounds of the diabetic foot. Ostomy Wound Manage 2002;48:64–8.
Webb LX, Pape HC. Current thought regarding the mechanism of action of negative pressure wound therapy with reticulated open cell foam. J Orthop Trauma 2008;22 10 Suppl:S135–7.
Chen SZ, Li J, Li XY, Xu LS. Effects of vacuum-assisted closure on wound microcirculation: An experimental study. Asian J Surg 2005;28:211–7.
Torbrand C, Wackenfors A, Lindstedt S, Ekman R, Ingemansson R, Malmsjö M. Sympathetic and sensory nerve activation during negative pressure therapy of sternotomy wounds. Interact Cardiovasc Thorac Surg 2008;7:1067–70.
Gabriel A, Shores J, Bernstein B, de Leon J, Kamepalli R, Wolvos T, et al. A clinical review of infected wound treatment with vacuum assisted closure (V.A.C.) therapy: Experience and case series. Int Wound J 2009;6 Suppl 2:1–25.
Assadian O, Assadian A, Stadler M, Diab-Elschahawi M, Kramer A. Bacterial growth kinetic without the influence of the immune system using vacuum-assisted closure dressing with and without negative pressure in an in vitro wound model. Int Wound J 2010;7:283–9.
Zhou M, Yu A, Wu G, Xia C, Hu X, Qi B. Role of different negative pressure values in the process of infected wounds treated by vacuum-assisted closure: An experimental study. Int Wound J 2013;10:508–15.
Scherer SS, Pietramaggiori G, Mathews JC, Prsa MJ, Huang S, Orgill DP. The mechanism of action of the vacuum-assisted closure device. Plast Reconstr Surg 2008;122:786–97.
Lizarov GA. The tension-stress effect on the genesis and growth of tissues: Part II. The influence of the rate and frequency of distraction. Clin Orthop Relat Res 1989;239:263–85.
Ferrara N. Molecular and biological properties of vascular endothelial growth factor. J Mol Med (Berl) 1999;77:527–43.
Labler L, Rancan M, Mica L, Härter L, Mihic-Probst D, Keel M. Vacuum-assisted closure therapy increases local interleukin-8 and vascular endothelial growth factor levels in traumatic wounds. J Trauma 2009;66:749–57.
Babiak I. Open tibial fractures grade IIIC treated successfully with external fixation, negative-pressure wound therapy and recombinant human bone morphogenetic protein 7. Int Wound J 2014;11:476–82.
Burchardt H. The biology of bone graft repair. Clin Orthop Relat Res 1983;174:28–42.
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Jha, R.K., Xia, C., Li, Z. et al. Combined negative pressure wound therapy with open bone graft for infected wounds with bone defects: An experimental study. IJOO 51, 318–323 (2017). https://doi.org/10.4103/ortho.IJOrtho_220_16
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DOI: https://doi.org/10.4103/ortho.IJOrtho_220_16