Abstract: Introduction: Compound fractures of the long bones take long time for union and wound healing due to issues such as soft tissue loss, infection etc., particularly cases with Gustilo Anderson III type of fractures. To accelerate wound healing in this setup, Vacuum Assisted Closure is gaining popularity to remove debris, blood or serous fluid by vacuum. Hence we decided to carry out a study of VAC therapy at our institute for management of compound fractures.
Material and Methods: We carried out a prospective follow-up study at MIMER Medical College, Talegaon Dabhade from June 2016 to December 2018 on 30 patients of compound grade IIIA and IIIB fractures of tibia and femur. In operation theatre wound was irrigated with saline, debridement was done for removal of dead, devitalised tissues including bone pieces (avascular) and fracture was fixed with external fixator or intramedullary interlocking nail as per need of individual case and then vacuum assisted wound therapy was done after debridement.Wound was assessed for size and healthy granulation tissue, infection etc. upon removal after 5 days and VAC therapy was repeated if necessary. Then after granulation (healthy) appeared either split skin graft, flap, or wound closure by suturing was done according to wound condition. Then patients were followed up every month after discharge after wound healing, for a period of six months.
Results: There were 18 males 12 females. Mean age of patients was 30.33 years. Bones involved were femur in 10 cases and tibia in 20 cases. Fracture type was grade III A in 22 pts and III B in 8 pts. Number of VAC applications were one in 19 patients, two in 10 patients, three in 1 patient. Duration of hospital stay was <21 days in 14 pts, 21-30 in 10 pts, >30 days in rest. Mean distribution of hospital stay 24.3 days. Time taken for appearance of granulation tissue was <2 weeks in 97.67% pts. Treatment method chosen for wound management after VAC Application Split Skin Graft was done in 11 pts, Flap in 4 pts. Bone infection was seen in 4 pts, hypoproteinemia in 7 pts only
Conclusion: Vacuum assisted wound closure appears to be a reliable treatment method for compound grade III A & B fractures of long bone without significant adverse effects
