Abstract
BackgroundMassive soft tissue loss involving the pelvis and extremities from trauma, infections, and tumors remains a challenging and debilitating problem. Although vacuum-assisted closure (VAC) technology is effective in the management of soft tissue loss, the adjunct of a silver dressing in the setting of massive wounds has not been as well tested.Questions/purposesDoes a silver negative pressure dressing used in conjunction with a wound VAC decrease (1) the length of acute hospital stay and overall length of treatment; (2) the number of surgical débridements the patients underwent as part of their care; and (3) the likelihood of wound closure without soft tissue transposition?MethodsWe evaluated 42 patients with massive (> 200 cm2) pelvic and extremity wounds from trauma, infection, or tumor who were treated with the wound VAC with or without a silver negative pressure dressing between January 2003 and January 2010; the first 26 patients were treated with the wound VAC alone, and in the final 16 consecutively treated patients, the silver dressing was added to the regimen. We reviewed medical records to determine length of treatment as well as the number and type of surgical interventions these patients underwent. We compared the group treated with the wound VAC alone with those patients treated with the wound VAC and silver negative pressure dressing.ResultsHospital stay averaged 19 days in the VAC only group and 7.5 days in the VAC with silver dressing group (p < 0.041), length of overall treatment averaged 33 days in the VAC only group and 14.3 days in the VAC with silver dressing group (p < 0.022), number of operative débridements averaged 7.9 in the VAC alone group and 4.1 in the VAC with silver dressing group (p < 0.001), and success of wound closure without soft tissue transposition was 16 of 26 patients in the VAC alone group and three of 16 patients in the VAC with silver dressing group (p < 0.033).ConclusionsBased on the reduced length of care and the number of surgical procedures these patients with massive wounds of the pelvis and extremities underwent, we now use the silver negative pressure dressing in combination with the wound VAC as part of routine care of such patients. These results may be used as hypothesis-generating data for future randomized studies.Level of EvidenceLevel III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Highlights
Massive pelvic and extremity soft tissue loss remains a complex and cumbersome problem
(1) the length of acute hospital stay and overall length of treatment; (2) the number of surgical debridements the patients underwent as part of their care; and (3) the likelihood of wound closure without soft tissue transposition? Methods We evaluated 42 patients with massive ([ 200 cm2) pelvic and extremity wounds from trauma, infection, or tumor who were treated with the wound vacuum-assisted closure (VAC) with or without a silver negative pressure dressing between January 2003 and January 2010; the first 26 patients were treated with the wound VAC alone, and in the final 16 consecutively treated patients, the silver dressing was added to the regimen
Based on the reduced length of care and the number of surgical procedures these patients with massive wounds of the pelvis and extremities underwent, we use the silver negative pressure dressing in combination with the wound VAC as part of routine care of such patients
Summary
Massive pelvic and extremity soft tissue loss remains a complex and cumbersome problem. The use of a silver negative pressure dressing in conjunction with the VAC may inhibit the colonization of drug-resistant organisms and sustain early granulation leading to expedited healing [27, 29,30,31]. Massive soft tissue loss involving the pelvis and extremities from trauma, infections, and tumors remains a challenging and debilitating problem. Vacuum-assisted closure (VAC) technology is effective in the management of soft tissue loss, the adjunct of a silver dressing in the setting of massive wounds has not been as well tested. Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained
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