Use Of Vacuum-assisted Closure Therapy Research Articles

The Effect of Vacuum-Assisted Closure Therapy on Methicillin-Resistant Staphylococcus aureus Wound Biofilms.

Biofilm-associated wound infections are a major global health issue, and methicillin-resistant Staphylococcus aureus (MRSA) is among the greatest therapeutic challenges. Vacuum-assisted closure (VAC) therapy is now being revisited as an alternative treatment for both acute and chronic wounds. However, data supporting the concept of its antibiofilm effect remain limited. Using quantitative biofilm-forming assay and a range of genotypic methods (spa, SCCmec, and agr typing), study authors showed that VAC therapy can significantly prevent biofilm formation (P < .01) of a range of MRSA wound isolates differing widely in their biofilm-forming abilities and genetic background. The best effect was presented on CC5-MRSA-SCCmecI-agrII, a dominant MRSA clone among wound isolates worldwide. An assessment of effects of different protocols on dressing changes (1 or 2 times per week) demonstrated significantly greater antibiofilm activity (P < .05) of 3-day dressing changes. These findings support the use of VAC therapy as a topical antibiofilm treatment for the effective management of wound healing.

Vacuum assisted closure: Review on current application for post-operative wound management in orthopaedics

Background: Post operative wound dehiscence is a significant health problem. In imposes social and financial burdens. If the injury involves the exposure of bone, early coverage of the defect must be a goal of treatment to prevent secondary problems such as an osteogenic infection. Vacuum-assisted closure (VAC) therapy has been developed as an alternative to the standard forms of wound management, which incorporates the use of negative pressure to optimise conditions for wound healing and requires fewer painful dressing changes. It is a wound management system that exposes a wound bed to local negative pressure to promote healing. This article reviews the use of VAC therapy in a post operative of wound. Material and method: A prospective study conducted in department of orthopaedic surgery, Grant medical college and sir JJ Group of hospital, Mumbai from 2016-2017. A total of 25 subjects were consecutively recruited. Patients included in study are classified according to the grade of the ulcer. Patients age group 21-70 years with the following risk factors and comorbidities diabetes mellitus, hypertension, chronic obstructive pulmonary disease, dyslipidaemia, and smoking. Post operative wound dehiscence of proximal tibia, distal tibia and olecranon selected. Pre and post VAC culture collected. Patients were evaluated post VAC after definitive management for functional outcome. Result: Our study of confirms that vacuum assisted closure is an excellent treatment modality for post operative wound dehiscence. Patients had an average of 8 treatment sessions. The duration of VAC application ranged from 12 to 36 days with an average hospital stay of 24 days. Amongst this maximum patients being in the age group of 30-70 years. VAC dressing found to produce more secondary closure of wound and split skin graft, also reduced more invasive procedures like flap surgery and in worst case amputation. Also it found reduces bacterial count of the wound. Conclusion: Promotes early rehabilitation, and alleviates the need for a second procedure. Significant reduction in hospital stay subsequent lower in hospital cost, decreased amputations, increasing the number of patients undergoing skin grafting and improving culture sterility.

Impact of vacuum-assisted closure therapy on outcomes of sternal wound dehiscence†.

Sternal wound dehiscence (SWD) after cardiac surgery is a rare but serious condition associated with considerable costs and morbidity. We sought to evaluate the results of the introduction of vacuum-assisted closure (VAC) therapy in the management of sternal wound dehiscence, compared with those of previous conventional treatments. We retrospectively collected 7148 patients who underwent cardiac surgery at our institution between January 2002 and June 2012. A total of 152 (2.1%) patients had a sternal wound dehiscence: 107 were treated with conventional treatments (Group A) and 45 were managed with VAC therapy (Group B). Patients were stratified according to preoperative risk factors and type of sternal wound dehiscence (superficial or deep; infected or not) and compared by means of a propensity-matched analysis. A cost analysis was also performed. Forty-five patients of each group matched for all preoperative risk factors and type of sternal wound dehiscence. SWD-related mortality rate was significantly lower in Group B (11 vs 0%; P = 0.05). Incidence of mediastinitis (P < 0.0001), sepsis (P = 0.04), delayed SWD infection (P = 0.05), other complication (P = 0.05), surgical sternal revision (P = 0.04) and surgical superficial revision (P < 0.0001) were all significantly lower in Group B. Mean patient cost was 31 106€ in Group A and 24 383€ in Group B, thus achieving a mean saving of 6723€ per patient. In our experience, the use of VAC therapy for the management of SWD was considerably effective in decreasing mortality (SWD related), incidence of complications and need for surgical procedures; thus, leading to a significant reduction of costs.

Buttock necrosis after hypogastric artery embolization for postpartum hemorrhage

Abstract Background: Uterine or hypogastric artery embolization is a useful alternative to hysterectomy in the treatment of postpartum hemorrhage. Case: Puerpera requiring a bilateral hypogastric artery embolization for postpartum hemorrhage after cesarean section in a term twin pregnancy. Unexpected unilateral buttock necrosis appeared 5 days later. Treatment consisted of debridement, the use of vacuum-assisted closure therapy and skin grafting. Conclusion: Buttock necrosis is a rare complication after hypogastric artery embolization in the treatment of postpartum hemorrhage.

The Use of Vacuum-Assisted Wound Closure Therapy in Thoracic Operations

Conventional treatment of complex, nonresolving empyemas after an episode of pneumonia or a chest operation often requires an open-window thoracostomy. This necessitates frequent, often painful dressing changes and is associated with prolonged hospitalization. The wound is often malodorous, causing significant social distress to patients and unquestionably affects their quality of life. We assessed the value of using vacuum-assisted closure (VAC) therapy in managing patients with a persistent infected pleural space. The study included 10 patients. All patients signed an informed consent and were debriefed before the procedure. An empyema developed in 1 patient after an episode of pneumonia. The other 9 had recently undergone a thoracic surgical procedure. All patients underwent initial open drainage of the pleural cavity and debridement. A VAC therapy system was then inserted intraoperatively or on the first postoperative day. The patients were discharged home with a portable VAC therapy system in situ. Subsequent dressing changes were managed by tissue-viability nurses in the community, without the need for further anesthesia or analgesia. Over a period of time, the cavity was sterilized and eventually obliterated spontaneously. All patients were mobilized early and fast-tracked through the hospital. This prevented the need for daily dressing changes; hence, minimizing the disruption of normal activities and reducing the need for nursing care. Overall, the length of hospitalization was shorter, and the VAC therapy facilitated closure of the infected wound cavity. The use of the VAC therapy system negated the need for a second surgical procedure to close the wound cavity. None of the patients reported pain, odor, or inconvenience associated with the VAC therapy system. Our observations suggest that the use of VAC therapy to treat such patients is safe, facilitates early discharge and recovery, and offers a "civilized," cost-effective treatment in a community setting.

Vacuum Assisted Closure Therapy in Severe Acute Pancreatitis: Case Report and Literature Review

Context Abdominal compartment syndrome (ACS) is one of the most worrisome complications of hemorrhagic necrotic pancreatitis (HNP) and its prevention or correct treatment is crucial for patient survival. Case report A 29-year-old male patient with clinical history of sarcoidosis and alcoholic consumption was admitted to our Surgical Unit in March 2012 with diagnosis of severe acute pancreatitis. Clinical evaluation and laboratory tests revealed concurrent sepsis and anemia (WBC 34.91 x10 3 /µL; PCR 34.76 mg/dL; LDH 714 U/L; Hb 10.1 g/L); a CT scan showed a wide pancreatic necrosis and multiple abdominal collections. These findings were suggestive of an infected pancreatic necrosis. A surgical abdominal toilette, necrosectomy and drainage of a large serous-hematic retroperitoneal collection were performed. In postoperative day 3, a gradual increase of intra-abdominal pressure (IAP: 22 mmHg) led up to an ACS, with respiratory distress, acute renal failure and paralytic ileus. Therefore, the patient underwent a second abdominal toilette, with laparostomy covered by a Bogota bag. This latter was replaced every 72 hours. In postoperative day 12, the onset of severe anemia brought to a third operation consisting in abdominal toilette, wide necrosectomy, hemostasis of proper hepatic artery and replacement of the Bogota bag. In postoperative day 22, the Bogota bag was replaced with a vacuum assisted closure (VAC) therapy. VAC therapy was then changed every 48-72 hours. Clinical conditions improved rapidly, in postoperative day 43 the laparostomy was closed with a biological mesh and a CT scan, performed in postoperative day 45, showed the complete resolution of abdominal inflammation and peripancreatic collections. Patient was discharged in postoperative day 68. Conclusion In literature, a standardized surgical strategy for ACS developed from HNP is missing. While the use of laparostomy is widely accepted, only few cases treated with VAC therapy are described. In our experience, laparostomy seemed a good “bridge” treatment, but the best results in terms of clinical response have been gained with the use of VAC therapy.

Experience with the use of vacuum-assisted closure therapy in the management of sickle cell leg ulcers

Leg ulcers are the commonest cutaneous manifestation of sickle cell disease, typically running an indolent course. They commonly occur around the distal third of the leg, an area notorious for difficult-to-heal wounds. The vacuum-assisted closure (VAC) device has been found efficacious in the management of chronic ulcers of varying aetiologies. However, reports on its use in the management of sickle cell ulcers are at best scanty. The purpose of this study was to determine the usefulness of VAC therapy in the management of sickle cell ulcers. Over an 18-month period, consecutive patients presenting at the plastic surgery centre of the Imo State University Teaching Hospital were managed using VAC therapy and subsequent skin grafting for extensive ulcers. Data were extracted from the case records after completion of wound care and analysed using descriptive statistics. There were seven males and two females aged 14–34 years with 15 ulcers affecting the distal third of the leg. Ulcer duration before commencement of VAC care ranged from 2.5 to 84 months. All wounds showed remarkable reduction in size, had healthy granulation tissue and were ready for skin grafting within 6–10 days of VAC care. Graft take was 98% to 100%. Use of the VAC device is valuable in the management of sickle cell ulcers. This device rapidly improves the vascularity of the wound bed and permits early successful coverage of sickle cell ulcers.

Description of a Technique for Vacuum-Assisted Deep Drains in the Management of Cavitary Defects and Deep Infections in Devastating Military and Civilian Trauma

Deep soft-tissue defects often present in high-energy trauma and during the surgical treatment of infection. Injuries caused by high-velocity projectiles can create deep soft-tissue defects that are challenging to manage. Persistent, deep wound cavities have been associated with infection and prolonged wound healing. This article presents a technique that marries vacuum-assisted wound closure technology with traditional drains to allow for management of deep soft-tissue cavities. A deep drain was placed in the cavitary lesion with application of a negative-pressure wound therapy sponge in the standard fashion. The deep drain was brought into the sponge and fenestrated as to allow the sponge to evacuate the deep drain. Several illustrative cases are presented. Conversion of deep cavitary defects to superficial defects allowed for delayed primary or secondary closure of the wound defects without the need for increasing the size of the superficial wound to facilitate drainage. Deep infection was also successfully controlled without incurring the additional surgical soft-tissue trauma typical of standard technique. The use of the active deep suction decreases edema and dead space, theoretically reducing the chance of infection. It also prevents premature walling off of deeper cavities, which can occur with the use of vacuum-assisted closure therapy on superficial defects. Our method of wound management allows for the reduction of the deep cavitary defects without delaying wound closure or creating more tissue damage.

Vacuum assisted closure of wounds – A review

Background: Vacuum-assisted closure (VAC) therapy is a new technique based on the principle of application of controlled negative pressure. This technique has revolutionized the concept of wound management in recent times.Method: This is a review article in which various aspects related to the use of VAC therapy are dealt with. Key words: Vacuum Assisted Closure (VAC), dressings, wound, negative pressure.

Wundauflagen und temporäre Weichteildeckung bei der Versorgung akuter und chronischer Wunden

Die Versorgung akuter sowie chronischer Wunden erfordert eine adäquate und stadiengerechte Intervention. In der Vergangenheit haben Schlagworte wie „Modernes Wundmanagement”, begleitet durch ein Fehlen evidenzbasierter Behandlungsrichtlinien, eher für eine Verunsicherung gesorgt. Zusätzlich existiert auf dem Markt eine unüberschaubare Produktpalette für die Wundversorgung. Die Behandlung chronischer Wunden ist oftmals komplex und langwierig, sodass die Auswahl der geeigneten Wundauflage auch zunehmend, bedingt durch den Kostendruck im Gesundheitssystem, eine immer wichtigere Rolle spielt. Aufgrund der Vielzahl von Wundauflagen ist neben der klinischen Erfahrung die Kenntnis der jeweiligen Wundstadien und Mechanismen der Heilungsverläufe unabdingbar. Insbesondere bei chronischen Wunden ist die begleitende Therapie der ursächlichen Grunderkrankung Voraussetzung für eine erfolgreiche Therapie. Die vorliegende Arbeit soll eine Übersicht über die aktuell gängigen Verfahren zur Behandlung von akuten und chronischen Wunden, den wichtigsten Wundauflagen und Überlegungen zur temporären Weichteildeckung einschließlich der Vakuumtherapie geben.

Use of VAC therapy and sternal plating in the treatment of sternotomy wound dehiscence

Sternal dehiscence has a high morbidity and mortality. Many treatment modalities have evolved. Early wound management and closure has a positive outcome. Vacuum-assisted closure (VAC) therapy has proven to be effective, and recently the closure of the sternum with internal plate fixation appears to be beneficial. We present a small series with their combined usage. We retrospectively reviewed eight cases of sternal wound dehiscence or sepsis referred to our unit for further management for the period January 2006 to December 2007. The subjects consisted of five males and three females with their ages ranging from 47 to 74 years (mean = 63 years). All patients had a premorbid history of hypertension and hyperlipidemia and five of diabetes. The patients were managed with a combination of serial debridement, VAC therapy, and sternal internal plate fixation and bilateral pectoralis major advancement flap. In three patients, final closure was obtained after sternal plating. Two patients achieved final closure by VAC therapy only. Three patients died of multiple-organ failure while undergoing wound bed preparation. We believe the use of VAC therapy and definitive wound closure using sternal plating, as part of a staged treatment, is an effective method for managing sternotomy wound dehiscence.

P. 266] Outcomes after Repeat Transsphenoidal Surgery for Recurrent Cushingʼs Disease

To the Editor: We read with interest the article by Donovan and Person (1). This article described the use of vacuum-assisted closure therapy for a large scalp defect resulting from resection of a rare adnexal scalp tumor with intracranial invasion. In this report, the authors demonstrated the use of vacuum-assisted closure therapy for successful closure of a wide scalp defect. Of note, this same case appears to have been published in 2004 in The Laryngoscope by different authors from the same facility (2). The main topic of this article is identical to the previous report and appears to have included the same patient. A review and comparison of the two articles shows that both contain multiple patient photographs and magnetic resonance imaging (MRI) scans. Photographs and MRI reproductions in the two articles are quite similar, and some appear to be identical. Additionally, the Donovan and Person article (1) did not reference the Laryngoscope publication. Although it is possible that the Donovan and Person article in NEUROSURGERY was submitted before publication of the Laryngoscope article and, therefore, was not referenced for that reason, this seems unlikely, given that there was nearly a 2-year interval between the publication of the two articles. The above suggests potential failings at multiple levels. First is the issue of copyright infringement, since, once submitted, photographs and reproductions become the property of the journal. Therefore, patient photographs and MRI reproductions cannot be reprinted without permission of the journal in which the photographs were first published. If the authors were unaware of the previous publication in The Laryngoscope, this still represents a potential failing. It is the primary responsibility of the author(s) to perform an adequate literature search when submitting a journal article. Today, with the advent of Medline searches, thorough reviews are mandatory. It is less surprising that neither the NEUROSURGERY reviewers nor the two invited discussants noted the above inconsistencies, since the original article was published in the otolaryngology (Ear, Nose, Throat [ENT]) literature. It is not the norm, nor is it reasonable, to expect reviewers and/or discussants to perform exhaustive literature searches of each article that they review. Therefore, it is imperative that situations such as this be reported and highlighted by NEUROSURGERY. This is the best way to minimize such instances and to assure the highest quality of our journal. Serdar Nasir James E. Zins Cleveland, Ohio

Giant Eccrine Adenocarcinoma of the Scalp with Intracranial Invasion

To the Editor: We read with interest the article by Donovan and Person (1). This article described the use of vacuum-assisted closure therapy for a large scalp defect resulting from resection of a rare adnexal scalp tumor with intracranial invasion. In this report, the authors demonstrated the use of vacuum-assisted closure therapy for successful closure of a wide scalp defect. Of note, this same case appears to have been published in 2004 in The Laryngoscope by different authors from the same facility (2). The main topic of this article is identical to the previous report and appears to have included the same patient. A review and comparison of the two articles shows that both contain multiple patient photographs and magnetic resonance imaging (MRI) scans. Photographs and MRI reproductions in the two articles are quite similar, and some appear to be identical. Additionally, the Donovan and Person article (1) did not reference the Laryngoscope publication. Although it is possible that the Donovan and Person article in NEUROSURGERY was submitted before publication of the Laryngoscope article and, therefore, was not referenced for that reason, this seems unlikely, given that there was nearly a 2-year interval between the publication of the two articles. The above suggests potential failings at multiple levels. First is the issue of copyright infringement, since, once submitted, photographs and reproductions become the property of the journal. Therefore, patient photographs and MRI reproductions cannot be reprinted without permission of the journal in which the photographs were first published. If the authors were unaware of the previous publication in The Laryngoscope, this still represents a potential failing. It is the primary responsibility of the author(s) to perform an adequate literature search when submitting a journal article. Today, with the advent of Medline searches, thorough reviews are mandatory. It is less surprising that neither the NEUROSURGERY reviewers nor the two invited discussants noted the above inconsistencies, since the original article was published in the otolaryngology (Ear, Nose, Throat [ENT]) literature. It is not the norm, nor is it reasonable, to expect reviewers and/or discussants to perform exhaustive literature searches of each article that they review. Therefore, it is imperative that situations such as this be reported and highlighted by NEUROSURGERY. This is the best way to minimize such instances and to assure the highest quality of our journal. Serdar Nasir James E. Zins Cleveland, Ohio

Experience with Vacuum-Assisted Closure of Sternal Wound Infections Following Cardiac Surgery and Evaluation of Chronic Complications Associated with its Use

We report our experience in use of Vacuum-assisted closure therapy (VAC) in the treatment of poststernotomy wound infection with emphasis on recurrent wound-related problems after use of VAC and their treatment. Between July 2000 and June 2003, 2706 patients underwent various cardiac procedures via median sternotomy. Forty-nine patients with postoperative sternal wound infection (1.9%) were managed with VAC. Wounds were classified as either superficial sternal wound infection (28 patients) or deep sternal wound infection (21 patients). In the superficial sternal wound infection group, 23 patients had VAC as definitive treatment (GroupA), while five patients (Group B) had VAC followed by surgical closure. Similarly, in the deep sternal wound infection group, 12 patients had VAC as definitive treatment (Group C), while nine patients had VAC followed by surgical closure (Group D). Patients were discharged after satisfactory wound closure. Upon discharge patients were followed up at interval of three to six months. Recurrent sternal problems when identified were investigated and additional surgical procedures were carried out when necessary. There were nine deaths, all due to unrelated causes except in one patient who died of right ventricular rupture (Group C). Nine patients in Group A had recurrent wound problems of which six had VAC system for > 21 days. Three patients underwent extensive debridement due to sternal osteomyelitis. All eight patients in Group B presented with chronic wound-related problems and underwent multiple debridements. Four patients had laparoscopic omental flaps. In contrast 14 patients (Group B and D) who were treated with shorter duration of VAC followed by either a flap or direct surgical closure, did not present with recurrent problems. VAC therapy is a safe and reliable option in the treatment of sternal wound infection. However, prolonged use of VAC system as a replacement for surgical closure of sternal wound appears to be associated with recurrent problems of the sternal wound. Strategy of use of VAC for a short duration followed by early surgical closure appears favorable.

Vakuumtherapie. Aktueller Stand der Grundlagenforschung

The gap between the broad clinical use of vacuum-assisted closure therapy (VT) and knowledge of the physiological mechanisms leading to its effectiveness is great. The value of the technique and its future development are dependent on research into these mechanisms. A meta-analysis evaluating the results of basic research on the effectiveness of VT was carried out based on peer reviewed publications. This is considered in relation to other therapeutic approaches of basic research to wound healing (growth factors etc.). Our study includes a concise description of the scientific background to the mechanisms of cell stimulation using basic work on tissue expansion, bone, vessel and nerve distraction as well as in vitro cell stimulation. Evaluation of the scientific data on all known effects of VT was made based on the results from experimental animal studies, the results of randomized clinical studies, observations on clinical applications and case reports. Assessment of the studies was based on design and significance as well as the appraisal of our own clinical experience. Data involving cellular effects (proliferation, synthesis, wound healing), systemic effects (mediators, systemic inflammatory disease), extracellular effects (perfusion, edema, local wound environment, stabilization, barriers) and complex effects of VT (inflammation, matrix function, blood supply) were examined. Systematic analysis of the data allows scientifically interested surgeons rapid access to the theme, the first, to this extent, extensive overview of the current scientific situation as well as a comprehensive bibliography for all areas involving the theme of mechanical cell stimulation. The authors list major areas for future research and encourage the development of multicenter studies.

Vacuum-Assisted Closure of the Sternotomy Wound: Respiratory Mechanics and Ventilation

Numerous authors have reported promising results with the use of vacuum-assisted closure therapy in poststernotomy mediastinitis. The negative pressure applied to the anterior mediastinum substantially exceeds the normal negative pressure in the pleural cavities, and interaction with respiratory physiology cannot be excluded. The aim of the present study was to evaluate whether the application of six clinically relevant negative pressures between -50 mmHg and -175 mmHg to the sternotomy wound affects respiratory parameters in a porcine model. A midline sternotomy was performed in six mechanically ventilated pigs weighing 70 +/- 3 kg. Vacuum-assisted closure therapy was applied with continuous negative pressure in a randomized order to the sternotomy wound. The following respiratory parameters were monitored by a carbon dioxide-based noninvasive monitoring system connected to the ventilator: carbon dioxide elimination, peak inspiratory pressure, peak expiratory flow, alveolar minute volume, alveolar tidal volume, expired tidal volume, static compliance, and airway resistance. All pigs survived the treatment, and there was no significant change in the respiratory parameters investigated at any of the six negative pressures applied. A tendency toward increased airway resistance was noted when -175 mmHg was applied, although this change was not significant. The application of negative pressure therapy in the treatment of deep poststernotomy infections is a novel modality gaining increased attention. In this study, no impairment in respiratory mechanics, ventilation, or oxygenation was detected when comparing applied pressures ranging from -50 mmHg to -175 mmHg in the sternotomy wound.

The Use of Vacuum-Assisted Closure Therapy for the Treatment of a Large Infected Facial Wound

Chronic wounds in difficult locations pose constant challenges to health care providers. Negative-pressure wound therapy is a relatively new treatment to promote wound healing. Laboratory and clinical studies have shown that the vacuum-assisted closure (VAC) therapy increases wound blood flow, granulation tissue formation, and decreases accumulation of fluid and bacteria. VAC therapy has been shown to hasten wound closure and formation of granulation tissue in a variety of settings. Accepted indications for VAC therapy include the infected sternum, open abdomen, chronic, nonhealing extremity wounds and decubitus ulcers. We report the first case of VAC therapy successfully used on a large infected wound to the face to promote healing.

Vacuum-Assisted Closure in the Treatment of Complex Gynecologic Wound Failures

In Brief BACKGROUND Complex wound failures are a source of significant morbidity and mortality. They are costly and time consuming to treat, and may evolve into chronic, debilitating conditions. Vacuum-assisted closure is a novel wound healing technique applying subatmospheric pressure to wounds to expedite healing. CASES We report the successful use of vacuum-assisted closure therapy on three patients on a gynecologic oncology service with complex wound failures of various chronicity. In all cases, vacuum-assisted closure therapy was well tolerated and demonstrated efficacy within 48 hours of initiation. CONCLUSION We conclude that vacuum-assisted closure therapy should be included in the armamentarium of the gynecologist addressing complex wound failures. Vacuum-assisted closure is effective and well tolerated in the management of complex gynecologic wound failures.

The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone.

Lower-extremity wounds with exposed tendon, bone, or orthopedic hardware present a difficult treatment challenge. In this series of patients, subatmospheric pressure therapy was applied to such lower-extremity wounds. Seventy-five patients with lower-extremity wounds, most of which were the result of trauma, were selected for this study. Dressings made of sterile open-cell foam with embedded fenestrated tubing were contoured to the wound size and placed into the wound. The site was covered with an adhesive plastic sheet. The sheet was placed beneath any external fixation devices, or the fixation device was enclosed within the sheet. The tubing was connected to the vacuum-assisted closure pump. Continuous subatmospheric suction pressure (125 mmHg) was applied to the wound site. The wounds were inspected and the dressings were changed every 48 hours.Vacuum-assisted closure therapy greatly reduced the amount of tissue edema, diminishing the circumference of the extremity and thus decreasing the surface area of the wound. Profuse granulation tissue formed rapidly, covering bone and hardware. The wounds were closed primarily and covered with split-thickness skin grafts, or a regional flap was rotated into the granulating bed to fill the defect. Successful coverage was obtained without complication in 71 of 75 patients. Wounds have been stable from 6 months up to 6 years.