Fri., 10/19/07 Tibia, Paper #23, 10:48 am OTA-2007
Routine Use of Wound Vacuum-Assisted Closure Does Not Allow Coverage Delay for Open Tibia Fractures
Timothy Bhattacharyya, MD (e-Stryker); Priyesh Mehta, BA (n);
R. Malcolm Smith, MD (n); Bohdan Pomahac, MD (n);
Partners Orthopaedic Trauma Service, Massachusetts General Hospital and
Brigham and Women’s Hospital, Boston, Massachusetts, USA
Background: Prevention of infection is a paramount concern after open fracture of the tibia. Previous studies have shown that delay in soft-tissue coverage may raise infection rates. Use of vacuum-assisted closure (VAC) devices in open fracture wounds has become common. We analyzed whether use of the VAC sponge can allow delay of flap coverage for open tibia fractures without an increase in infection rate.
Methods: We identified 38 patients with grade IIIB open fractures from our trauma registry with minimum 1-year follow-up. From the medical record we collected information on the time from injury to definitive wound coverage, type of fixation, type of coverage, and demographics. Infected cases were defined as cases that required surgical débridement after coverage with positive cultures.
Results: Patients who underwent definitive coverage within 7 days had a significantly decreased rate of infection (12.5%) compared to patients who had coverage at 7 days or more postinjury (54%, P <0.008). Overall infection rate was 36% with routine use of the VAC sponge. Patients who developed infection had a greater mean time to coverage than patients who did not develop infection (8.9 days versus 4.8 days, P <0.029).
Conclusions: Routine use of the VAC with open tibia fractures is safe and provides a good primary dressing over open wounds. For IIIB tibia fractures, VAC therapy does not allow delay of soft-tissue coverage past 7 days without a concomitant elevation in infection rates.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.