27. NEGATIVE PRESSURE WOUND THERAPY FOR OPEN LEG FRACTURES: 42 CASES

Abstract

Purpose of the study: This was a retrospective analysis of patients with bone loss subsequent to an open leg fracture. Negative pressure therapy was applied in 42 cases over a period of 47 months.

Material and method: Our strategy was designed around the goal of secondary rather than emergency cover, after preparation of the wound bed with NPWT. The time from the first surgical care to NPWT was 23.38 days on average. Mean duration of NPWT was 21.19 days.

Results: After NPWT, gain in wound surface was 18.09% on average. The gain was nil for 52.38% of the patients, positive for 47.62% and exceptional for 4.76%. 100% of the wounds analysed developed a regular border which prepared a bed for a graft or flap without decreasing the depth of the wound. NPWT enabled all patients to reach the set objective: directed healing in 19%, skin graft in 48%, flap in 33%. The objective were achieved for 66% of patients, exceeded, partially achieved for 14% and not reached for 10%.

Discussion: We conclude that NPWT is an excellent way to wait for slow healing after cleaning. It stimulates formation of a granulation tissue, favours the development of regular borders, and cleans the wound before definitive surgical treatment. Thus whether achieved with a flap, a graft or directed healing, the final cover is thus minimised. NPWT can also reduce the risk of infection during the initial phase since the wound is drained and outside contamination is limited by the air-tight dressing. Cost remains a limitation even though certain studies have found equivalent cost with conventional dressings, often related to use of lower cost “homemade” dressings.