The Use of Multiple Negative Pressure Wound Therapy Modalities to Help Manage Extensive Wounds Caused by a...

Vehicular run-over accidents cause crushing and sheering forces that can result in fractures and cause extensive damage to the cutaneous layer of the skin and underlying soft tissues. These types of injuries present immense challenges that often require numerous treatment modalities for wound management. A complex case in which 2 distinct negative pressure wound therapy (NPWT) modalities were instrumental in helping manage extensive wounds resulting from extreme crushing/sheering forces is presented.

A 22-year-old male without prior medical history presented to the treating facility after falling and being crushed by a parade float. The patient had multiple fractures to the facial area and pelvic region, including the left side of the sacrum. The injuries encompassed the entire perineum, rectal area, scrotum, and both upper legs. After stabilizing the patient, attention was directed to the extensive wound and eventual closure. Following muscle flap reconstructions to help protect the left and right femoral arteries, an acellular artificial skin was placed to cover the perineum, bilateral medial thighs, and left groin region. Upon developing wound complications, NPWT with instillation and dwell time (NPWTi-d) was applied by intermittently instilling 60 mL of normal saline solution with a 10-minute dwell time, followed by negative pressure at -125 mm Hg for 3.5 hours. The therapy was applied for 11 days with dressing changes every 2 to 3 days. The patient then underwent split-thickness skin grafting to the left thigh, perineum, and right thigh. Due to the extensive nature of the wounds and the multiple anatomical locations, a novel 4-channel NPWT system was used as a bolster over the skin grafts. Continuous NPWT was applied at -125 mm Hg for 2 weeks with dressing changes occurring every 2 to 3 days. There was complete take of all skin grafts 17 days post-grafting, and the patient has since healed. The patient is now walking and has resumed normal daily activities.

For this case, combining treatment modalities was beneficial in healing a patient's complex trauma wounds and shows a potential treatment strategy in this population of wounds.