Introduction: Periprosthetic infection remains a main complication in arthroplasty. In case of a possible infection the surgeon has to have a concept of treatment which can be individually adjusted. Materials and Methods: To increase the success of implant retaining surgery VAC Instill therapy combining instillation of an antiseptic solution and VAC therapy was performed in 23 patients with periprosthetic hip infections. 19 patients had an early and 4 a late infection of the arthroplasty. Lavasept was used for irrigation. Results: Definitive wound closure was possible in all patients following 2.1 VAC exchange operations in average. The follow up was 19 months in average. In five of the 23 patients (22%) there was recurrent infection which made the explantation of the implant necessary. In early infection the success rate was 84%, in late infection 50%. Conclusion: VAC Instill therapy can be successfully used for salvage of infected endoprosthesis especially in case of early infection. The success rate seems to be higher than irrigation alone or suction drainage

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

The purpose of the study was to retrospectively assess the patients treated to date with the vac ulta system using a technique of antibiotic instillation. The vac ulta system is licensed for use with anti-septic instillation fluid but we have now treated a number of patients with antibiotic instillation under the guidance of the microbiology department. All patients being treated with the vac ulta system were included in the study. There were no exclusions. Pathology treated, infecting organism, antibiotic used and length of treatment were all recorded. Any antibiotic related complications were noted. Treatment was judged successful with resolution of presenting symptoms, normalization of inflammatory markers and three negative foam cultures. There were 21 patients included in the study. There were 13 male and 8 female patients. Length of treatment ranged from 1 week to 10 weeks with a mean of 4.2 weeks. Follow up ranged from 1 month to 42 months with a mean follow up of 17.9 months. The most common pathogen was Staph. Aureus(11 cases). Enterobacter, ESBL, Strep. Milleri, MRSA and Citrobacter were also treated. Antibiotics instilled included flucloxacillin, meropenem, gentamicin, vancomycin, meropenem and teicoplanin. There were no antibiotic reactions/allergies. Pathologies treated included osteomyelitis, two stage amputations for infection, infected non-union and infected metalwork. Infection recurred in 2 of 21 patients (10%), with one recurring at 18 months and one at 2 years. The 90% treatment success rate is highly encouraging in this notoriously difficult group of patients to treat. In this series vac instill was an effective treatment of infection and allows antibiotic treatment to be targeted to the infected tissues. There were no adverse reactions seen. Larger series with longer follow up are no needed but we believe this technique is safe, successful and easily administered can be cautiously adopted on a wider basis

Posttraumatic infection and osteomyelitis is a difficult to treat complication. Despite surgical interventions, there is great risk for recurrence of the infection and development of an invalidating osteomyelitis. For this reason, a retrospective, case control cohort study on patients with posttraumatic osteomyelitis was performed to evaluate the clinical outcome of a new therapy, i.e. VAC Instillation with Lavasept®, an instillation technique applied after the initial surgical debridement. In the time period from 2/1999 to 2/2003, thirty three patients with posttraumatic osteomyelitis were included and were treated with the VAC technique and the white polyvinyl alcohol (PVA) foam in combination with lavasept® instillation. The PVA foam was instilled 3 times per day with a disinfectant fluid agent lavasept 0.2 % (polyhexanidum solution). The average time of treatment was 21 days (6–60). The average time that infected wounds became sterile or skin bacteria could be cultured (88.1 %) was 12 days (range 4 – 38; SD 8.9). The follow-up time was up to 72 months. For comparison a historical control group of 94 patients (male 58, mean age 47 (r 9–85) matched for site and severity of osteomyelitis, was identified in hospital records for a period of 20 years (1982–2002). These patients were treated with debridement, lavage and gentamycin beads. Both groups were statistical comparable to sex, age, comorbidity and site of the osteomyelitis. In the V.A.C.® Instill® group the rate of recurrence of infection was 3/30 (10%), whereas 55/93 (58.5%) of the controls had a recurrence (p< 0.0001). Moreover, in those treated with VAC Instillation, the duration of hospital stay was shorter and the number of admissions and surgical procedures were smaller as compared with the controls (all p< 0.0001). We conclude that in posttraumatic osteomyelitis VAC Instillation treatment may improve clinical outcome and reduce the need for repeated surgical interventions and hospital admissions in comparison to the present standard approach

Our experience using a skin stretching device applying KW and rib retractors for the approximation of extensive skin loss in the treatment of complex injuries involving massive loss of soft tissue is presented. Major soft tissue injury inflicted by the detonation of explosives in close proximity requires a unique approach for the closing of massive gaping wounds. This method has been applied in multiple situations at our medical center since 1995. The technique involved insertion of the KW into the deep dermal layer along the longitudinal edges on both sides of the wound, and the application of rib retractors to approximate the skin edges. Lately we have been combining this method with vacuum-assisted skin closure (VAC). This method enabled closure of massive soft tissue losses of limbs, trunks, and abdominal wall. Approximation of wound edges necessitated in some cases minor skin grafting of the residual gap. Application of the VAC system reduced edema, infection rate and skin necrosis, and also enabled early skin grafting. We will describe the novel use of VAC in extensive soft tissue trauma. The KW stretching device is inexpensive and is readily available in any OR setup. It enables setting of a vector traction on wound edges in a more homogenous manner. The VAC system may be combined for optimizing treatment

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.

To describe clinical situations for use of modified VAC in POC based on: diagnosis, comorbidities, BMI, wound size in cm, days following trauma when VAC was first applied, total duration of uninterrupted use, frequency of change, settings, bacterial growth, outcomes. To report the outcomes of mVAC use in POC within 6 months to help improve and standardize its application in the institution. This study involves data gathering from inpatients handled by orthopedic surgeons in training and subspecialty rotations in POC. The data collected are highly dependent on the doctors-in-charge's complete charting, thorough reporting and accurate documentation. Modified Vacuum Assisted Closure (mVAC) is used frequently in this study and is defined as a form of revised, adapted and reformed use of VAC based on available materials in the involved institution. The materials that are included are, but not limited to the following: sterile Uratex™ blue foam, nasogastric or suction tubing, phlegm suction machine, Bactigras™ and Opsite™ or Ioban™. A total of 58 patients were included in the study. The average age of the population was 35 and are predominantly male. The most common mechanism of injury was motorcycle accident and 37 of the patients were diagnosed with an open fracture of the lower extremity with open tibia fractures (22) being the most common. Average wound area measured was 24.12 cm. 3. All patients yield a bacteria growth with e. coli being the most frequent. Average during of uninterrupted use was 39 days. Of the 58 included in the study, 8 patients underwent STSG, 2 had a flap coverage surgery, 4 patients eventually underwent amputation and 33 with complete resolution of soft tissue defect after conversion to biologic dressing post-mVAC. The rest of the population were still ongoing mVAC at the end of the study. mVAC is an alternative temporary medium for soft tissue coverage for cases with or without concomitant fractures. mVAC promotes removal of exudate from the wound, supports wound apposition and granulation bed proliferation. Usage mVAC helps prepare for skin coverage procedure and on some cases leads to full resolution of defect

Aim. The purpose of this study is to analyze the demographic and microbiological variables of acute ankle infections posterior to ankle osteosynthesis and to determine the different characteristics of patients withE. cloacae infection. Method. A multicenter retrospective observational study (4 national hospitals) of acute post osteosynthesis infections of ankle fracture operated between 2015 and 2018 was implemented. The demographic and microbiological variables relating to the surgical intervention and the antibiotic treatment performed were collected. A descriptive assessment of all the variables and a univariate comparison between patients with E. cloacae infection and patients with alternative microorganism infections were performed. The SPSS v25 program for Windows was the choice for statistical analysis. Results. 71 Patients with an average age of 57 years were included, the majority being males (55%). 31% of patients were diabetic, 27% had vascular pathology, and 18.3% had a BMI greater than 35. Trimalleolar fracture was the most common in our study being 52%. 26.8% were open fractures. The microorganisms isolated were: 25% S. aureus, 22.5% E. cloacae and 22.5% polymicrobial. Accounting for polymicrobial infections, the presence of E. cloacae rises to 32%. In the univariate analysis, only significant differences were found in age (patients with E. cloacae infection were older) and the use of VAC therapy. Conclusions. In our series, higher percentages of E. cloacae infection were observed than those described in the literature. There are statistically significant differences in the variables of age and need for VAC therapy. The high incidence of E. cloacae infections suggests the vital importance of adapting antibiotic prophylaxis, ensuring the coverage of this microorganism

Introduction. Ankle replacement is a major surgery with significant soft tissue dissection and bleeding. The skin quality is often poor in these patients due to age, edema, venous congestion, arteriopathy or previous procedures and soft tissue injury. The chances of wound infection increase with delayed wound healing. Absorbent non-adherent dressing (ABD) and VAC dressing applied in theatre after ankle replacement were assessed in a cohort of 147 patients with wound complications, pain, satisfaction and length of stay as outcome measures. Patients and methods. 71 consecutive patients were treated with ABD post-operatively after ankle replacement. The practice was then changed to VAC dressings for 76 consecutive patients. 44 patients had additional procedures performed with ankle replacement (11 from ABD group and 33 from VAC group). Retrospective analysis of prospectively collected data was performed. All patients had daily pain score, wound status, hospital stay, satisfaction and range of movement recorded. Results. Patients with VAC had mean pain score of 3/10 post operatively compared with 6/10 with ABD. There was a significant difference between the length of stay between the groups (p=0.02). The average stay of stay was 9 days with ABD and 7 days with VAC dressing. One of the patients with VAC dressing had blisters and 1 patient developed a superficial wound infection. Of the ABD group, 3 patients developed blisters and 7 patients had wound complications after ABD. Range of movement was similar in both groups of patients. Patient's satisfaction with VAC dressing was 8/10. Conclusion. VAC is better than ABD as primary dressing after ankle replacement

Introduction. Since the expanded war in Ukraine in 2022, explosives, mines, debris, blast waves, and other factors have predominantly caused injuries during artillery or rocket attacks. These injuries, such as those from shelling shrapnel, involve high-energy penetrating agents, resulting in extensive necrosis and notable characteristics like soft tissue defects and multiple fragmentary fractures with bone tissue defects and a high rate of infection complications caused by multi resistant gram-negative (MRGN) pathogens. Material and Methods. We conducted a prospective study at our center between March 2022 and December 2023. Out of the 56 patients from Ukraine, 21 met the inclusion criteria who had severe war injuries were included in the study. Each of these patients presented with multiple injuries to both bones and soft tissues, having initially undergone treatment in Ukraine involving multiple surgeries. The diagnosis of infection was established based on the EBJIS criteria. Prior to our treatment patients had undergone multiple revision surgeries, including debridement, biopsies, implant and fixator replacement. Additionally, soft tissue management required previously VAC therapy and flap reconstruction for successful treatment. Results. All 21 infections manifested as bone infections (11; 52%), followed by implant-associated infections (5; 24%), soft tissue infections (4; 19%), and septic arthritis (1; 5%). In all patients, the infection was polymicrobial, caused by 3- and 4-MRGN pathogens, as Klebsiella pneumonia 4MRGN, Proteus mirabilis 4MRGN, Enterobacter cloacae 4MRGN etc. Upon admission, all patients carried a diagnosis and exhibited signs indicative of chronic infection. 19 (90.5%) patients required complex antibiotic regimens combined with multiple wound revisions and debridements, changes of fixators and combination of systemic and local antibiotic therapy. In 6 patients (28%) high dosages of local antibiotics such as gentamycin, vancomycin and meropenem were incorporated into a carrier of bio-absorbable calcium sulfate, calcium sulfate/hydroxyapatite which were introduced into the hip joint, femoral canal or bone defect for dead space management during the surgery. When local antibiotics were administered at intervals, the microbiology results at implantation showed negative results. 2 (9%) patients had new infections (different site, different pathogens), 1 (4.8%) is still under the treatment. In 17 (81%) patients infection complications were treated successfully with no recurrence of infection. Conclusion. War injuries result in complex bone and soft-tissue infections caused by 3-, 4-MRGN pathogens. Addressing this challenge necessitates multidisciplinary approach with multiple, thorough surgical debridements, effective local, and systemic antimicrobial therapy. As for the outlook we can see potential in local antibiotic carriers

Aim. Pelvic osteomyelitis following pressure ulceration results in substantial patient morbidity. Previous studies have reported a heterogenous approach to diagnosis and medical management by physicians, suggesting equipoise on key clinical questions. This study hypothesised that the same equipoise exists amongst Orthopaedic surgeons. Method. An 18-question multiple-choice questionnaire was designed through an iterative feedback process until the final version was agreed by all authors. Likert-type scale responses were used with graded responses (e.g., never/fewer than half of patients/around half of patients/more than half of patients/every patient). The online survey was sent to members of the Musculoskeletal Infection Society (MSIS), the European Bone and Joint Infection Society (EBJIS), and the ESCMID Study Group for Implant-Associated Infections (ESGIAI). No incentive for participation was provided. Results. Amongst respondents, 22/41 were based in Europe and 10/41 from the USA. The majority (29/41) had been in clinical practice between 5—24 years. There was a high priority placed on bone biopsy histology, culture-positive bone sampling, and palpable bone without periosteal covering for diagnosis. Multidisciplinary team approach with plastic surgery involvement at the index procedure was advocated. The strongest indications for surgical intervention were source control for sepsis, presence of an abscess/collection, and prevention of local osteomyelitis progression. Physiological/psychological optimisation and control of acute infection were the primary determinants of surgical timing. There was low utilisation of adjunctive surgical therapies. Local/regional primary tissue transfer or secondary healing with/without VAC were the preferred techniques for wound closure. Recurrent osteomyelitis was the most common reason for prolonged antimicrobial therapy. The majority received bedside advice from an infectious disease-specialist but a quarter of respondents preferred telephone advice. Conclusions. Amongst an international cohort of Orthopaedic Surgeons there was a heterogenous diagnostic and therapeutic approach to pressure-related pelvic osteomyelitis

Objective: Primary reconstruction of soft tissues in acute complex lower limb injuries is often mandatory in order to protect exposed bones, nerves, tendons and/or vessels, however it may be precluded by general clinical and/or local wound conditions. Vacuum assisted closure (VAC. ®. ) has been introduced in the management of complex wounds for its ability to remove third space fluids, improve oxygen delivery to the wound bed, while it promotes angiogenesis and granulation. This retrospective study evaluates the use of VAC. ®. in lower limb trauma patients unsuitable for immediate reconstruction. Patients and Methods: Fourty-two patients, 24 males and 18 females, with 49 complex lower limb traumas were treated with VAC. ®. therapy for a mean of 28 days (range 15–42 days). Mean age of patients was 47 years (range 21–82). All patients included were characterized by poor general condition or adverse local wound factors. VAC. ®. was applied 24–48 hours after bone fixation, vascular repair and surgical debridement of non viable tissues so as to minimize the risk of bleeding and ensure viability of soft tissues in the wound bed. Wound swab cultures were obtained before the application of VAC. ®. and before every change of sponge. The duration of therapy, wound flora, final reconstructive technique required, outcome and follow up period were recorded for each patient. Results: Seventeen patients were over 65 years of age, 28 were Intensive Care Unit patients, 11 had heavily exuding wounds and in 9 the viability of soft tissues after initial debridement was questionable. Patients were followed up for 60 to 395 days. Two wounds (4%) healed spontaneously, 6 (12.2%) were managed with delayed direct suture, 31 (63.2%) were managed with skin grafts, 8 (16.3%) required local flaps. Two patients died during therapy due to concurrent conditions. In all but one patient, wound bacterial flora was progressively reduced during therapy. Scars were aesthetically acceptable, however, in 7 wounds hypertrophic scars were treated with triamcinolone injections combined with silicone sheeting. Conclusion: VAC. ®. is a safe and effective method facilitating delayed soft tissue reconstruction in complex lower limb traumas in high risk patients. The development of healthy granulation tissue minimizes the need for major conventional reconstructive operations and therefore postoperative morbidity

Aim. Negative pressure wound treatment (NPWT) has been widely adopted in the management of septic wound complications or prophylactically after large surgeries. Recent publications have indicated the necessity of further investigations to support the use of NPWT with more evidences. Therefore, the purpose of this pilot-study was to investigate the efficacy of VAC-assisted dressing systems in the treatment of septic trauma cases. Method. We analysed data of 16 retrospective cases following traumas and septic soft tissue surgeries around the hip and knee. The collected data consisted of bacterial cultures, inflammatory markers (WBC, CRP/HCRP) and body temperature, taken periodically during treatment. Also recorded were the time periods the vacuum pump was used during treatment. To increase the number of measurements and to facilitate subsequent data analysis, the measurements were interpolated to regularly sampled curves with a sampling rate of one day. We used cross-plots and linear regression analysis to investigate trends in the data: 1) while the vacuum pump was switched on and 2) while it was switched off. Results. The analysis shows that the average WBC and CRP/HCRP values decline in the first days after initiation of the VAC treatment. WBC values decline in the first four days of VAC treatment (linear regression, R. 2. =0.960). CRP/HCRP values decline in the first thirteen days (linear regression, R. 2. =0.952). No meaningful trends were observed in body temperature measurements. Importantly, there is a trend for an increase of WBC and CRP/HCRP, following the 4. th. and 14. th. days, respectively. These findings suggest that the prolonged use of VAC treatment may result in secondary relapses. Conclusions. Our results indicate a marked decrease of inflammatory markers during the first two weeks, confirming the efficacy of NPWT in the management of septic wounds after traumas. Importantly, our analyses also show a periodic relapse with the prolonged use of NPWT. However, further studies are needed with a larger, standardized population to confirm these findings

One of the most challenging cases encountered by orthopaedic surgeons is chronic osteomyelitis. The mainstays of successful treatment include: radical debridement, stabilisation of the bone if necessary; control of infection and finally skin cover or closure. Negative pressure dressings have been used for over 10 years in the treatment of acute and chronic wounds with recognised benefits. Topical negative pressure wound therapy with instillation of solution in the local area (VAC Instill Therapy System®) is a new device available in the armamentarium of a limb reconstruction surgeon. This device automatically delivers instillation fluid into the infected wound, where this fluid is held for a while before application of topical negative pressure. This cycle helps remove infectious material leading to clean closed moist environment for better wound healing. Senior authors (MGD and SLR) have used this VAC Instill therapy in 10 cases of chronic osteomyelitis from April 2007 to November 2008. All patients have been included in this study. All patients had (thorough) bony and soft tissue debridement followed by application of VAC Instill therapy with local delivery of antibiotics. All patients were male with mean age of 39 years (range 20–56 years). There were eight cases of tibial osteomyelitis, one distal radial and one calcaneal osteomyelitis. Most had mixed growth, with Staphylococcus being most common infecting organism. Average duration for VAC Instill therapy was 32 days (range 20–71 days). Average hospital stay was 33 days (range 15–85 days) and average time to wound closure was 39 days (range 19–90). There were two failures of treatment one later had Lautenbach procedure and other had below knee amputation. We conclude that VAC Instill therapy is very successful in the management of chronic osteomyelitis. These are the only early results available in the literature. Further studies are needed to back these findings

The October 2015 Foot & Ankle Roundup. 360 . looks at: TightRope in Weber C fractures; A second look at the TightRope; Incisional VAC comes of age?; Platelet-derived growth factor and ankle fusions; Achilles tendon rehab in the longer term following surgery; Telemedicine for diabetic foot ulcer

Aims: The aims of this study were to 1) determine if vacuum assisted closure therapy (VAC) helps assist closure in diabetic foot ulcers and wounds secondary to peripheral vascular disease, 2) if it helps debride wounds and 3) if it prevents the need for further surgery. Materials and Methods: 15 patients were reviewed, average age 49.3yrs at an average of 6.3 months (1–18months). Ten patients had diabetes (8 IDDM) with 5 patients having grade 3 ulcers (Wagner-Meggitt). All wounds were surgically debrided prior to the application of the VAC therapy. The VAC therapy was applied according to the manufacturers instrucrtions. The main outcome measures were 1) time to satisfactory wound closure 2) change in the wound surface area and 3) need for further surgery. Results: Satisfactory healing was achieved in 11 patients (73.3%). 10 were diabetic, 5 patients had peripheral vascular disease and 5 patients had both. The time to satisfactory healing was 2.5 months, average 1–6 months. The average size of the wound ulcer was 7.41cm2 (2–10cm2) prior to treatment and 1.58cm2 (0–2cm2) following treatment in an average of 2.5 months. VAC therapy helped debride all non healing wounds following surgical debridement. In 10 patients, the need for further radical surgery, namely amputation, was avoided. Conclusion: VAC therapy is a useful adjunct to the standard treatment of chronic wound /ulcers in patients with diabetes with or without periphearl vascular disease. Its use in foot and ankle surgery leads to a quick wound closure and in some cases avoids the need for further surgery with a potential for limb salvage

Chronic posttraumatic osteomyelitis (CPTO) is a complex condition that results in considerable morbidity and may be limb threatening. Tibia is the most common site of CPTO, with an average infection rate of 10% for open fractures and 1% for closed fractures. In most cases osteomyelitis is polymicrobial. Staphylococcus aureus is the most common infecting organism present either alone or in combination with other pathogens in 65 to 70% of patients. Adequate soft-tissue coverage is one of the cornerstones in chronic osteomyelitis management. Vacuum-assisted closure (VAC) is frequently used for the treatment of posttraumatic osteomyelitis of the extremities. After debridement and repeated VAC dressing changes, the wounds are closed by secondary suture, split-thickness skin grafts or local flaps. Free muscle flaps are recommended in distal third tibial defects. We present our experience with two case reports. The authors present two cases of type IIIA osteomyelitis according to Cierny-Mader classification, following previous distal third tibial open fractures. Both patients presented with limb deformity, insidious local pain and chronic purulent discharge (without significant local inflammatory signs) after 11 and 24 years of trauma. They were treated with radical debridement of all nonviable and infected tissue, VAC instillation therapy for 3 weeks and transverse rectus abdominis muscle (TRAM) flap defect coverage. Intra-operative cultures were positive for multiple pathogens. Specific antibiotic therapy was performed for each case for 8 weeks. Symptomatic relieve was achieved and C-reactive protein and white blood cell count returned to normal values. No complications were documented. 1 year post-surgery, both patients remain asymptomatic, with no signs of infection, with full flap integrity and gait without assistance. Despite the challenging management of chronic posttraumatic osteomyelitis of the tibia, infection control and a satisfactory functional outcome can be achieved. The cornerstones of management include infection control with surgical debridement, microbial-specific antibiotic administration and soft tissue coverage. VAC instillation therapy has an important role promoting granulation tissue formation and infection eradication. The aggressive approach, even with delay on diagnosis, is the key factor for a worthy outcome. Despite the good results, recrudescence of osteomyelitis is known to occur even years after the original offense is treated

Aims. The aims of this study were to determine if vacuum assisted closure (VAC) therapy affords quicker wound closure in diabetic and ischaemic wounds or ulcers than standard treatment, if it helps debride wounds and if it prevents the need for further surgery. Materials and methods. We retrospectively reviewed 12 patients, average aged 52.1 yrs (22 to 67) at an average of 6.3 months (1 to12 months). Seven had diabetes and three had chronic osteomyelitis. All wounds or ulcers were surgically debrided prior to application of the VAC therapy. The VAC therapy was applied according to the manufacturers instructions. The main outcome measures were the time to satisfactory healing and the change in the wound surface area. Results. Satisfactory healing was achieved in six patients (50%), seven were diabetic and one patient had peripheral vascular disease. The average time to satisfactory healing was 2.5 months, (1 to 6 months). The average size of the wound /ulcer was 7.41 cm2 prior to treatment and 1.58 cm2 following treatment for an average 2.5 months in those in whom the wound/ulcer was still present. VAC therapy helped debride all wounds which remained sloughy following surgical debridement. In 8 patients the need for further surgery, such as soft tissue flaps or more radical surgery was avoided. Conclusion. VAC therapy is a useful adjunct to the standard treatment of chronic wound /ulcers in patients with diabetes or peripheral vascular disease. Its use in foot and ankle surgery leads to a quicker wound closure and in some cases, avoids the need for further surgery. There are significant economic cost savings with its use in foot and ankle surgery

The April 2014 Trauma Roundup. 360 . looks at: is it safe to primarily close dog bite wounds?; conservative transfusion evidence based in hip fracture surgery; tibial nonunion is devastating to quality of life; sexual dysfunction after traumatic pelvic fracture; hemiarthroplasty versus fixation in displaced femoral neck fractures; silver VAC dressings “Gold Standard” in massive wounds; dual plating for talar neck fracture; syndesmosis and fibular length easiest errors in ankle fracture surgery; and dual mobility: stable as a rock in fracture

The December 2012 Trauma Roundup. 360. looks at: whether tranexamic acid stops bleeding in trauma across the board; antibiotic beads and VAC; whether anaesthetic determines the outcome in surgery for distal radial fractures; high complications in surgery on bisphosphonate-hardened bone; better outcomes but more dislocations in femoral neck fractures; the mythical hip fracture; plate augmentation in nonunion surgery; and SIGN intramedullary nailing and infections