Vacuum-Assisted Closure (V.A.C.^®) for Temporary Coverage of Soft-Tissue Injury in Type III Open Fracture of Lower Extremities

Abstract

Background and Purpose:

The difficulty in the treatment of severe open fractures is a high infection rate and the problem of an adequate temporary coverage of the soft-tissue damage between successive second-look operations. The vacuum-assisted closure (V.A.C.^®) offers good temporary soft-tissue coverage with a proven bacterial clearance and protects, at the same time, the soft tissue against secondary damage. The retrospective study reports the soft-tissue management of severe open fractures of Gustilo type IIIA and IIIB with V.A.C.^® or Epigard^®.

Patients and Methods:

All open fractures were in the lower extremity and a result of a nonpenetrating trauma. V.A.C.^® was used as a temporary dressing in 14 fractures and an Epigard^® in twelve fractures.

Results:

One early amputation was observed in each group. In the group with the soft-tissue coverage by Epigard^®, in spite of less type IIIB fractures and less polytraumatized patients, the rate of infections (6/11) was substantially higher compared with patients managed by V.A.C.^® therapy (infection: 2/13).

Conclusion:

V.A.C.^®, a temporary soft-tissue substitute, reduces the rate of infection and is an alternative of choice for the management of type III open fractures.