A role for vacuum-assisted closure in lower limb trauma: a proposed algorithm

The British Association of Plastic Surgeons and British Orthopaedic Association estimate that 70% of Gustilo 3b tibial fractures require flap coverage. Prior to the introduction of vacuum-assisted closure (V.A.C.) in the late 1990s, options were limited for the treatment of such injuries in selected individuals with medical comorbidity or complex wounds. VAC has now become an important part of our algorithm for soft tissue reconstruction with excellent results, but its role has not yet been defined in common management pathways. The authors present 3 cases, all different in their mechanism of injury, type of injury, and subsequent management, but all had a successful outcome with VAC.