Treatment of soft tissue defects in pediatric patients using the VAC(TM) system

Twenty-seven consecutive pediatric patients presenting to the orthopaedic s urgery or plastic surgery services were reviewed after completion of wound care with the Vacuum Assisted Closure (V.A.C.(TM)) system. Each patient pre sented with complex soft tissue wounds requiring coverage procedures. Patie nts with acute wounds and wounds present after nonsuccessful attempts at su rgical closure (dehisced incisions and failed flaps) were treated. All soft tissue defects healed without extensive coverage procedures using the V.A. C.(TM) system. In the majority of patients, use of the V.A.C.(TM) system pr oduced a profuse bed of granulation tissue over all exposed bone, tendon, j oint, and/or hardware, which could be covered with split thickness skin gra ft. Other patients were treated successfully with delayed primary closure, local flap advancement (one patient underwent a pedicled cross-leg flap), o r by secondary intention. Use of the V.A.C.(TM) device is valuable in incre asing the rate of granulation tissue formation and healing of extensive sof t tissue injuries in pediatric patients. This vacuum system aids in the deb ridement of necrotic tissue and local soluble inflammatory mediators that m ay inhibit the proliferation of granulation tissue. These improvements in t he local wound environment seem to accelerate wound healing compared with t raditional methods. Before the development of the V.A.C.(TM) system, a mini mum of nine patients within this group would have required free tissue tran sfer to obtain adequate coverage. The V.A.C.(TM) device seems to permit ear lier coverage with local tissue or split-thickness skin grafting techniques , thereby decreasing the need for extensive microvascular tissue transfers in pediatric patients.