Historically, amputation or rotationplasty were the treatment of choice in skeletally immature patients. The introduction of expandable endoprostheses in the late 1980s offered the advantages of limb-salvage and limb length equality at skeletal maturity and a promising alternative with improved cosmetic results and immediate weight bearing. to describe the Rizzoli experience in reconstruction with three different types of expandable prostheses in growing children with malignant bone tumors of the femur, assess the outcome of limb salvage in these patients, analyze survival and complications related to these prostheses used over time.Introduction
Objective
The purpose of this study is to compare the healing progress in cases with wound healing complications with or without VAC assistance. From 2005 to 2008, 32 patients with a mean 56 years of age had wound healing complications necessitating for further operative intervention. 26 cases were classified as stage III and 6 cases were classified as stage IV according to the National Pressure Ulcer Advisory Panel. The mean extent of wounds was 7cm2. 17 cases (group A) were treated with repeated removal of necrotic debris. In 15 cases (group B) the VAC device was applied (75mmHg). The 2 groups were compared on the basis of total hospital stay, need for additional operation, and re-infection rates. Mean hospital stay was 25.2 days in group A and 16.5 days in group B (p<
0.05). 7 cases needed re-operation in group A comparing to 2 in group B (p<
0.05). Re-infection appeared in 5 cases of group A comparing to 1 case of group B (p<
0.05). 1 patient of group B used VAC therapy in lower negative pressure (50mmHg) 6 days post application due to unrelenting pain. Negative pressure wound therapy is safe and effective. It minimises the total hospital stay, it is associated with lower recurrence, re-infection and re-operations rates, and lowers total cost of therapy.
