TS6: TOPICAL NEGATIVE PRESSURE (TNP) WOUND MANAGEMENT IN MULTI-TRAUMAS WITH PELVIC FRACTURES

Abstract

Pelvic fractures in multi-trauma patients are an indicator of severe trauma and often require advanced wound management of pelvic, abdominal or extremity injuries. Poor wound management may result infected pelvic hardware, necessitating revision surgery. We propose that TNP is a safe method of wound management and report our experience.

In 2006 91 multi-trauma patients required pelvic/ace-tabular fixation at The Alfred, either internal or external. Of those, 23 needed TNP for wound care of pelvic, abdominal or extremity injuries. Indications for TNP included Morel-Lavelle lesions, concomitant bladder disruption with anterior wounds, severe edema preventing any wound closure, extremity open fractures/degloving/fasciotomies and post-op infections.

The average age of the group was 33, the average injury severity score was 36, 5 were female, 18 were male. There was one pelvic wound infection that resolved with TNP and local wound care. Two unsalvageable limbs (one transhumeral, one transfemoral) required amputation after TNP, all others were either closed primarily or with a flap and skin graft. There was one death in the group from unrelated causes. Pelvic scores, SF-12, visual analog pain scores and sexual dysfunction rates are being gathered and will be reported.

Topical negative pressure is a safe and effective method of managing complex wounds in multi-trauma patients with pelvic injuries.