Trephination and Subatmospheric Pressure Therapy in the Management of Extremity Exposed Bone

Abstract

Distal lower and upper extremity wounds with bone and tendon exposure present unique challenges to reconstructive surgeons. The limitations of the local anatomy usually make simpler reconstructive modalities such as primary closure and skin grafting difficult. As a result, wounds in this area, especially ones with bone or tendon exposures, are classically treated with free tissue transfer. Limb preservation using the combination of bone trephination and subatmospheric pressure therapy is described. Six cases with preserved extremities are presented. Three cases illustrate extremity wound with bone and tendon exposure healing through pregrafting wound optimization (bone trephination) with the use of subatmospheric pressure therapy. This treatment may offer an alternative method of limb salvage, in cases where flaps or free tissue transfer are not possible or optimal.