Delayed Soft Tissue Coverage after Negative Pressure Wound Therapy in Open Fractures of Lower Extremities

Hematoma refers to the collection or extravasation of blood, usually clotted, in a closed tissue space. It is caused by leakage from local vessels damaged by blunt trauma, local injury, or surgical dissection. In the postoperative phase, a hematoma often results in edema, pain, wound dehiscence, infection, and scarring of the surgical wound. We describe a 44-year-old woman who developed severe complications, including hematoma, abscess, failure of internal fixation, and loss of soft-tissue structures, after hallux abducto valgus surgery. Hospitalization was required for infection control, soft-tissue coverage through negative-pressure wound therapy, and first metatarsophalangeal joint stabilization through external fixation. Early recognition of the signs of infection and hematoma can help decrease the incidence of postoperative complications. (J Am Podiatr Med Assoc 97(5): 410–414, 2007)

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Early soft tissue coverage and negative pressure wound therapy optimises patient outcomes in lower limb trauma

Yearbook of Plastic and Aesthetic Surgery ◽

10.1016/j.yprs.2012.06.032 ◽

2013 ◽

Vol 2013 ◽

pp. 32-33

Author(s):

J. Boehmler

Keyword(s):

Soft Tissue ◽

Patient Outcomes ◽

Negative Pressure ◽

Lower Limb ◽

Negative Pressure Wound Therapy ◽

Soft Tissue Coverage ◽

Wound Therapy ◽

Limb Trauma ◽

Lower Limb Trauma

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Early soft tissue coverage and negative pressure wound therapy optimises patient outcomes in lower limb trauma

Injury ◽

10.1016/j.injury.2011.09.003 ◽

2012 ◽

Vol 43 (6) ◽

pp. 772-778 ◽

Cited By ~ 62

Author(s):

David Shi Hao Liu ◽

Foti Sofiadellis ◽

Mark Ashton ◽

Kirstie MacGill ◽

Angela Webb

Keyword(s):

Soft Tissue ◽

Patient Outcomes ◽

Negative Pressure ◽

Lower Limb ◽

Negative Pressure Wound Therapy ◽

Soft Tissue Coverage ◽

Wound Therapy ◽

Limb Trauma ◽

Lower Limb Trauma

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Incisional Negative Pressure Wound Therapy for Resection of Soft Tissue Tumors

Case Medical Research ◽

10.31525/ct1-nct03900078 ◽

2019 ◽

Author(s):

Keyword(s):

Soft Tissue ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Soft Tissue Tumors ◽

Wound Therapy

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How influential is the stiffness of the foam dressing on soft tissue loads in negative pressure wound therapy?

Medical Engineering & Physics ◽

10.1016/j.medengphy.2021.02.001 ◽

2021 ◽

Vol 89 ◽

pp. 33-41

Author(s):

Aleksei Orlov ◽

Amit Gefen

Keyword(s):

Soft Tissue ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Wound Therapy

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659 Non-Burn Etiologies Treated with Autologous Skin Cell Suspension: A Case Series Demonstrating the Efficacy in Complex Wounds

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.324 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S195-S195

Author(s):

Nicole M Kopari ◽

Yazen Qumsiyeh

Keyword(s):

Soft Tissue ◽

Cell Suspension ◽

Negative Pressure ◽

Wound Closure ◽

Negative Pressure Wound Therapy ◽

Case Series ◽

Dermal Substitute ◽

Wound Therapy ◽

Skin Cell ◽

Complex Wounds

Abstract Introduction Complex wounds (CW) resulting from necrotizing soft tissue infections (NSTIs) and soft tissue traumatic injuries create unique challenges. Radical debridement is often the first step in management but can result in disfigurement with impaired function and compromised cosmesis. The standard of care at our institution for full-thickness burn injuries of similar complexity is widely meshed autografting with application of autologous skin cell suspension (ASCS). Our study is a case series reviewing outcomes using ASCS for CW from non-burn etiology. Methods A retrospective chart review from March 2019 through July 2020 was performed to evaluate the effectiveness of ASCS and widely meshed autografting in CW. Patients presenting with CW underwent serial excisions of devitalized tissue by acute care and burn surgeons. Dermal substitute utilization for wound preparation was at the discretion of the surgeon. Definitive wound closure was achieved using ASCS in combination with a widely meshed autograft. The wounds were covered with a non-adherent, non-absorbent, small pore primary dressing along with bismuth-impregnated, petroleum-based gauze or negative pressure wound therapy dependent on wound bed contour. Further padding with gauze was applied along with compressive dressing. Results In total, 8 patients with CW were included in this review. The mean age was 58 years (range 27-85) with an equal number of males and females. Wound etiology included NSTI (n=5), degloving injury (n=2), and traumatic amputation (n=1). The average wound size measured 1,300cm2 (range 300-3,000). 50% of the patients were treated with a dermal substitute and negative pressure wound therapy prior to ASCS and autograft placement. 7 of 8 patients received split-thickness skin grafting in the ratio of 3:1 with one patient grafted at a 2:1 expansion. 7 of the 8 patients had >90% wound closure within 8-10 days of ASCS and autograft application. One patient had significant graft failure after removing surgical dressings and autograft in the early post-operative period secondary to dementia. One patient expired during the follow-up period secondary to medical comorbidities. The 6 remaining patients had durable wound closure and acceptable cosmetic outcome. All patients were discharged within 10 days of ASCS application with 4 patients discharging home and 4 patients discharging to an acute inpatient rehabilitation. Conclusions This study is the first case series to review ASCS in combination with widely meshed skin grafts in the management of CW from a non-burn etiology. Durable, timely wound closure and an acceptable cosmetic outcome was achieved in these often-challenging CW.

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Negative pressure wound therapy versus conventional dressing for open fractures in lower extremity trauma

The Bone & Joint Journal ◽

10.1302/0301-620x.102b7.bjj-2019-1462.r1 ◽

2020 ◽

Vol 102-B (7) ◽

pp. 912-917 ◽

Cited By ~ 2

Author(s):

Muhammad Tahir ◽

Ejaz A. Chaudhry ◽

Faridullah K. Zimri ◽

Nadeem Ahmed ◽

Saeed A. Shaikh ◽

...

Keyword(s):

Wound Infection ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Mean Difference ◽

Open Fractures ◽

Life Assessment ◽

Wound Therapy ◽

Significant Difference ◽

Gauze Dressing ◽

Secondary Outcomes

Aims It has been generally accepted that open fractures require early skeletal stabilization and soft-tissue reconstruction. Traditionally, a standard gauze dressing was applied to open wounds. There has been a recent shift in this paradigm towards negative pressure wound therapy (NPWT). The aim of this study was to compare the clinical outcomes in patients with open tibial fractures receiving standard dressing versus NPWT. Methods This multicentre randomized controlled trial was approved by the ethical review board of a public sector tertiary care institute. Wounds were graded using Gustilo-Anderson (GA) classification, and patients with GA-II to III-C were included in the study. To be eligible, the patient had to present within 72 hours of the injury. The primary outcome of the study was patient-reported Disability Rating Index (DRI) at 12 months. Secondary outcomes included quality of life assessment using 12-Item Short-Form Health Survey questionnaire (SF-12), wound infection rates at six weeks and nonunion rates at 12 months. Logistic regression analysis and independent-samples t-test were applied for secondary outcomes. Analyses of primary and secondary outcomes were performed using SPSS v. 22.0.1 and p-values of < 0.05 were considered significant. Results A total of 486 patients were randomized between January 2016 and December 2018. Overall 206 (49.04%) patients underwent NPWT, while 214 (50.95%) patients were allocated to the standard dressing group. There was no statistically significant difference in DRI at 12 months between NPWT and standard dressing groups (mean difference 0.5; 95% confidence interval (CI) -0.08 to 1.1; p = 0.581). Regarding SF-12 scores at 12 months follow-up, there was no significant difference at any point from injury until 12 months (mean difference 1.4; 95% CI 0.7 to 1.9; p = 0.781). The 30-day deep infection rate was slightly higher in the standard gauze dressing group. The non-union odds were also comparable (odds ratio (OR) 0.90, 95% CI 0.56 to 1.45; p = 0.685). Conclusion Our study concludes that NPWT therapy does not confer benefit over standard dressing technique for open fractures. The DRI, SF-12 scores, wound infection, and nonunion rates were analogous in both study groups. We suggest surgeons continue to use cheaper and more readily available standard dressings. Cite this article: Bone Joint J 2020;102-B(7):912–917.

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