Management of Wounds with Exposed Bones or Tendons in Children by Vacuum-Assisted Closure Therapy: A Prospective
Altaf Rasool1, Sheikh Adil Bashir1, Prince Ajaz Ahmad2
1Department of Plastic Surgery, Sher-i- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India.
Insights
Vacuum-assisted closure (VAC) therapy is an effective and safe treatment for complex pediatric wounds involving exposed bones or tendons. This method offers a cost-effective alternative to traditional flap procedures in children.
Area of Science:
- Pediatric Surgery
- Wound Management
- Biomedical Engineering
Background:
- Managing complex soft tissue defects with exposed bones/tendons in children presents significant surgical challenges.
- Traditional flap procedures are difficult in pediatric patients due to small vessels, long operative times, and perioperative risks.
- Vacuum-assisted closure (VAC) therapy offers a novel approach for complex pediatric wounds.
Purpose of the Study:
- To evaluate the efficacy of vacuum-assisted closure (VAC) therapy.
- To assess VAC therapy in managing pediatric wounds with exposed bones or tendons.
Main Methods:
- A study included 46 pediatric patients with complex wounds exposing bones/tendons from July 2016 to June 2018.
- Patients received vacuum-assisted closure (VAC) therapy for an average of 12 days.
- Outcomes included structural coverage, definitive wound management, and complication rates.
Main Results:
- Over 90% structural coverage was achieved in 89% of patients.
- 89% of wounds were definitively managed with split-thickness skin grafts.
- The average daily cost of VAC therapy was 187 Indian rupees, with no major complications reported.
Conclusions:
- Vacuum-assisted closure (VAC) therapy is an efficient and safe treatment option for complex pediatric wounds.
- VAC therapy demonstrates cost-effectiveness in the pediatric population.
- This modality simplifies the management of challenging pediatric wounds.
Abstract:
Background The management of complex soft tissue defects with exposed bones/tendons is always a challenging task for the surgeon and the problem becomes more pronounced when it comes to the management of these wounds in children. Though flap procedures are considered the standard for managing the complex soft tissue defects with exposed bones/tendons yet small blood vessels for anastomosis, long operative period, increased chances of perioperative thrombosis, and difficult perioperative management in children add to the difficulty in performing flap procedures in children. The vacuum-assisted closure (VAC) therapy has emerged as a novel modality for the management of the difficult wounds with added advantages, especially in children. Objective To evaluate the efficacy of VAC in the management of wounds with exposed bones/tendons in children. Patients and Method Forty-six children of complex wounds with exposed bones/tendons were included in the study from July 2016 to June 2018. Results Out of 46 patients, 31 were male; the patients had a mean age of 8.4 years. Road traffic accident was the most common mode of injury (54%), with most of the wounds located over extremities. The mean duration of VAC therapy was 12 days. More than 90% coverage of the exposed structure was seen in 89% of patients. The wounds were definitively managed by split-thickness skin graft in 89% of patients and flap cover in 6.5% of patients. The mean cost of the VAC therapy at our government run hospital was 187 Indian rupees per day. No significant major complications were seen during the treatment. Conclusion VAC therapy is an efficient, safe, and cost-effective modality of treatment for the management of complex wounds in the pediatric population.
