Traditional treatment of tibia and fibula fractures complicated with skin soft tissue defect is mainly external fixation, wound debridement and dressing plus skin graft or skin flap transplantation after the infection is controlled and granulation grow. This method is disadvantageous due to high cost, great pain, long hospitalization stay, infection and necrosis, even the possibility of amputation.OBJECTIVE:
To explore the clinical efficacy of vacuum sealing drainage (VSD) and external fixator in the treatment of tibia and fibula open fractmes complicated with skin defects.METHODS:
A total of 38 patients with severe open fractures of tibia and fibula complicated with skin defects were selected from Benxi Central Hospital between January 2009 and September 2013. The size of skin defects was more than 5 cm2. After external fixation, the patients underwent complete debridement and dressing, followed by VSD treatment for 5-7 days. After granulation tissue grew and the wound became fresh, the patients received intermedite thickness skin graft. And 15 cases treated without VSD were retrospectively selected, serving as control group. The infection control rate and wound healing time in the two groups were compared.RESULTS AND CONCLUSION:
After 5-7 days of VSD treatment, VSD dressings were removed, wound infection was controlled, local wound granulation tissue was fresh. Both the wound and fractures were healed well, no osteomyelitis or amputation occurred. Among the involved 38 patients, 23 cases were cured, 12 cases were effective, and three cases were ineffective. The total effective rate showed significant differences compared with the control group (92% vs. 53%; P < 0.05). VSD can completely remove the wound secretions and necrotic tissue, improve local microcirculation, eliminate the infection, VSD plus external fixator and skin grating is a simple and effective method in treatment of tibia and fibula open fractures with soft tissue defects.
Subject headings: biocompatible mateirals; drainage; soft tissue injury; skin transplantation
Zhao JH, Fang X. Vacuum sealing drainage plus skin transplantation repair skin soft tissue defects in tibia and fibula complicated fractures. Zhongguo Zuzhi Gongcheng Yanjiu. 2014;18(20):3246-3251.