Vacuum-assisted closure – a management option for the burns patient with exposed bone

Abstract

Exposed bone, secondary to debridement of severe burns to the lower limb, presents a challenge to the plastic surgeon. Techniques to provide soft tissue cover, such as local tissue advancement are limited, due to the severe thermal damage to the tissue surrounding the wound. Free tissue transfer may be relatively contraindicated by the patient’s systemic problems. Until such soft tissue cover can be provided, split thickness skin grafting will not be successful. Limb amputation is sometimes the only option available to this group of patients. The advent of vacuum-assisted closure (VAC) devices has changed many wound management practices. This technique, first described by Argenta and Morykwas [1,2], involves the insertion of a foam sponge into the wound cavity and achieving an airtight seal with the adhesive covering. Subatmospheric pressure is then applied. Wound healing is thought to be promoted by the removal of interstitial oedema, the increase in local blood flow and stimulation of granulation tissue formation secondary to negative pressure application [1–3]. Tissue bacterial counts have also been shown to be reduced [1,2]. We present a series of three patients, all of whom had severe lower limb burns with exposed bone following debridement, in whom vacuum-assisted closure dressings were applied and helped achieve soft tissue cover. Subsequent split thickness skin grafting was possible for wound closure, and limb salvage was achieved in each case.