A Suitable Option for Gustilo and Anderson Grade III Injury

BACKGROUND The management of Gustilo and Anderson grade III injury remains difficult, particularly due to the incidence of wound infections, delayed fracture union, and traumatic extremity amputation. However, little data is available on delayed skin graft or flap reconstructions of Gustilo grade III injury, especially using new technologies of wound coverage, such as vacuum sealing drainage (VSD) combined with limited internal and/or external fixation. MATERIAL AND METHODS Between June 2008 and May 2013, we performed the VSD technique combined with limited internal and/or external fixation on 38 patients (22 males and 16 females, with a mean age of 36.5 years) with Gustilo and Anderson grade III injury. VSD was regularly changed and delayed skin grafts or flaps were used to cover the defect. Two patients were lost to follow-up, and the remaining 36 were available for evaluation. The complications, wound healing, infections, and bony union were assessed for a mean duration of 2.5 years (range, 1-4 years). RESULTS Complications were seen in 5 of the 36 cases: 2 cases had infection alone, 1 case had delayed union or nonunion, 1 case had infection and delayed union, and 1 case had wound necrosis, infection, and nonunion. VSD was regularly changed 2-6 times. Morphological appearance and functional recovery were satisfactory in all cases. CONCLUSIONS Using VSD before skin grafts or flaps coverage, combined with limited internal and/or external fixation, is a suitable option for Gustilo and Anderson grade III injury.