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Low-cost vacuum assisted closure therapy for extensive musculoskeletal trauma and infection: Outcomes, efficacy and limitations

Vol 41 | Issue 1 | Jan-Jun 2020 | page: 21-25 | Anurag Singh, Damodar Panda, Jitendra Mishra, Aniruddh Dash


Authors: Anurag Singh [1], Damodar Panda [1], Jitendra Mishra [1], Aniruddh Dash [1]

[1] Department of Orthopaedics, IMS & SUM Hospital, Bhubaneswar, Odisha India.

Address of Correspondence

Dr. Anurag Singh,
IMS & SUM Hospital, Bhubaneswar, Odisha India.
E-mail: goanurag007@gmail.com


Abstract

Introduction: High-energy musculoskeletal trauma with extensive soft tissue loss is difficult to treat and underlying fracture makes it more cumbersome. This prolongs hospitalization and regular conventional dressings increase socio-economic burden. Vacuum assisted closure (VAC) was developed to prepare wound for early definitive management. It acts by decreasing edema, exudates, bacterial counts and promotes granulation tissue formation, neovascularization, approximates wound edges.
Aim: To evaluate outcomes, efficacy and limitations of low-cost VAC for management of extensive soft tissue loss and infected wounds.
Materials and Methods: This study was conducted in Dept. Of Orthopedics of a tertiary care hospital from December 2018 to July 2019 on 53 patients, either with extensive soft tissue injury following acute trauma or those with infected-necrotic wound. Forty two patients had acute trauma history while remaining 11 had infected non healing wound. Cultures were sent pre and post VAC application and antibiotic coverage was administered. Low cost VAC was applied after debridement and changed after every 3 – 4 days.
Results: Forty eight cases treated with low-cost VAC were ready for skin graft/flap/secondary suture after 1 to 3 cycles (4 to 12 days) of therapy. Another two cases developed spontaneous re-epithelization. The wound infection was controlled in 70% of the cases. Three patients did not achieve desired result due to limitations of the procedure.
Conclusion: Low-cost VAC has proved to be effective while being substantially cheaper (1/16th of conventional VAC). Its role is limited when the depth of wound is far greater than its length.
Keywords: Low cost VAC, Vacuum assisted closure, wound management, Negative pressure wound therapy, Soft tissue loss, Compound fracture.


References

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How to Cite this Article: Singh A, Panda D, Mishra J, Dash A. | Low-cost vacuum assisted closure therapy for extensive musculoskeletal trauma and infection: Outcomes, efficacy and limitations . | Odisha Journal of Orthopaedics & Trauma | Jan-June 2020; 41(1): 21-25.

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Negative pressure wound therapy… A healing touch approach to difficult wounds in orthopedic practice… A systematic review

Vol 41 | Issue 1 | Jan-Jun 2020 | page: 41-45 | Bikram Kar, Buddhadeb Nayak, Harshal Sakale, Alok C Agrawal


Authors: Bikram Kar [1], Buddhadeb Nayak [1], Harshal Sakale [1], Alok C Agrawal [1]

[1] Department of Orthopaedics, SCB Medical College, Cuttack, Odisha India.

Address of Correspondence
Dr. Buddhadeb Nayak,
SCB Medical College, Cuttack, Odisha India.
E-mail: buddhadeb9188@gmail.com


Abstract

The routine use of Negative Pressure Wound Therapy (NPWT) in big and complex wounds has gained the momentum over the past couple of years .In addition to surgical debridement for treating tissue defects around open fractures and chronic non healing ulcers, contaminated wounds in orthopaedic trauma, open fractures with soft tissue defects, its usage is frequently seen with increasing evidence to aid closed incisions having high risk of wound breakdown. Also the evidence for its use on skin grafts is now well established.
This review will analyze the available literature in order to summarize the current understanding of NPWT in terms of its mechanism of action, its applications, complications, contraindications and its future. Research on the application of NPWT in treating chronic non-healing wounds has largely taken the form of case studies, single-center studies, non-randomized controlled trials, with few randomized controlled trials (RCTs). Our aim is to summarize the current and emerging indications for negative pressure wound therapy in Orthopaedic trauma and the existing evidence for its use.
Keywords: Negative pressure wound therapy, Open fractures, Trauma, Wound management.


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How to Cite this Article: Kar B, Nayak B, Sakale H, Agrawal A C. | Negative pressure wound therapy… A healing touch approach to difficult wounds in orthopedic practice… a systematic review. | Odisha Journal of Orthopaedics & Trauma | Jan-June 2020; 41(1): 41-45 .

(Abstract) (Full Text HTML)      (Download PDF)