Negative-pressure wound therapy in pediatric extremity trauma: a single-institution experience

Abstract

Background The value of negative-pressure wound therapy as a bridge to definitive closure of traumatic extremity wounds has been established in adults. Negative-pressure wound therapy has been used to assist granulation tissue formation and promote closure of wounds. In this study, we evaluated our experience with negative-pressure wound therapy for pediatric extremity wounds requiring delayed closure. Patients and methods A prospective study was conducted on 20 pediatric patients presenting with extremity injuries involving soft-tissue defects not suitable for immediate primary closure. Initial evaluation of the traumatized patient, wound irrigation, debridement, and antibiotic therapy were carried out and a plan for each case was outlined. Negative-pressure wound therapy was established using the vacuum-assisted closure system and dressings were changed every 3 days before definitive closure either by skin graft, Integra dermal matrix followed by skin graft, or local flaps. Results Granulation tissue was noted in all wounds by day 3. The mean duration of vacuum therapy was 12±3.3 days in patients whose wounds were closed by local flap advancement (n=4), 9±3.6 days in patients whose wounds were closed by skin grafts (n=8), and 6±4.8 days in patients whose wounds were closed by Integra dermal matrix (n=8). There was no incidence of skin graft or Integra losses. All local flaps healed complet ely. The mean follow-up period was 18±6.8 months, during which no complications were noted. Conclusion As a relatively atraumatic wound care technique with little complications, negative-pressure wound therapy provides a highly effective option as a bridge for soft-tissue management of extremity trauma in pediatric patients.