開放骨折における低コストの土着真空閉鎖療法と標準的創傷療法との比較：ランダム化比較試験

Vacuum-assisted closure (VAC) has many advantages over standard wound therapy. However, its availability and associated high cost can be a disadvantage to the patients of developing countries, especially those coming from a poor background. There are some off-the-shelf indigenous-made VAC systems that can reduce the cost of VAC therapy by 20 times. However, there is a paucity of level one evidence on their efficacy. A randomized controlled trial was planned to evaluate the efficacy of indigenous VAC therapy as compared to standard wound therapy (SWT).

A double-blinded randomized controlled trial was conducted from December 2023 to April 2025. A total of 80 patients with Gustilo-Anderson type II/IIIA/IIIB open fractures were included in the study. After randomization, two groups (each containing 40 patients) were created. Group A received indigenous VAC therapy, and Group B received SWT. Outcomes such as duration of hospital stay, wound healing time, decrease in size of wound, formation of granulation tissue, infection rates, and other complications were assessed. The collected data were analyzed using SPSS v20.0.

VAC Group had a statistically significant shorter duration of hospital stay (28.65 vs. 41.97 days, P = 0.002) and wound healing time (29.55 vs. 45.87 days, P = 0.017) as compared to the SWT group. Wound size reduction and granulation tissue formation were also found to be significantly better in the VAC group. Apart from this, infection rates were also lower in the VAC group (P = 0.045).

The use of indigenous VAC significantly reduces hospital stay, shortens healing time, lowers the incidence of deep infections and complications, and enhances granulation tissue formation when compared to SWT. Due to substantially reduced cost of treatment and better results, we strongly recommend the adoption of indigenous VAC systems for early wound management, especially in developing countries.