The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone

Lower-extremity wounds with exposed tendon, bone, or orthopedic hardware pr esent a difficult treatment challenge. In this series of patients, subatmos pheric pressure therapy was applied to such lower-extremity wounds. Seventy -five patients with lower-extremity Wounds, most of which were the result o f trauma, were selected for this study. Dressings made of sterile open-cell foam with embedded fenestrated tithing were contoured to the Wound size an d placed into the wound. The site was covered with an adhesive plastic shee t. The Sheet was placed beneath any external fixation devices, or the fixat ion device was enclosed within the sheet. The tubing was connected to the v acuum-assisted closure pump. Continuous subatmospheric suction pressure (12 5 mmHg) was applied to the wound site. The wounds were inspected and the dr essings were changed every, 48 hours. Vacuum-assisted closure therapy greatly reduced the amount of tissue edema, diminishing the circumference of the extremity and thus decreasing the sur face area of the wound. Profuse granulation tissue formed rapidly, covering bone and hardware. The wounds were closed primarily and covered with split -thickness skin grafts, or a regional flap was rotated into the granulating bed to fill the defect. Successful coverage was obtained without complicat ion in 71 of 75 patients. Wounds have been stable from 6 months up to 6 yea rs.