Kumaar Arun, Shanthappa Arun H, Hongaiah Deepak, Sanjay Nandini, Sharma Abhi
Orthopaedics, Sri Devaraj Urs Medical College and Research Institute, Kolar, IND.
Plastic Surgery, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND.
Cureus. 2024 Feb 7;16(2):e53801. doi: 10.7759/cureus.53801. eCollection 2024 Feb.
Background Open fractures are common and serious injuries that primarily affect young males. Fracture management has improved in the last decade. However, infections with their complications are still a concern, especially in open fractures for primary closure of the injured area. A newer technique called vacuum-assisted therapy has become a therapy of choice for many orthopedic surgeons. This study aimed to determine whether vacuum-assisted closure reduces the duration of wound healing and the frequency of infections after fixation of Gustilo-Anderson Type IIIA/IIIB fractures of the extremities. Methodology An observational analytical study was conducted among 34 patients with Gustilo-Anderson Type IIIA/IIIB fractures of the limbs who presented to the Department of Orthopaedics, R. L. Jalappa Hospital, Kolar, from December 2019 to July 2021. Negative-pressure wound therapy was employed for wound closure after fixation of fractures. Patients were followed up for one month. Results The mean age of the patients was 37.06 ± 10.340 years. The prevalence of infection before vacuum-assisted closure dressing was 80.6%, and the prevalence of infection after vacuum-assisted closure dressing was 19.4%. The difference in proportion before versus after the intervention was statistically significant (p < 0.001) according to the McNemar Test. Hence, vacuum-assisted closure dressing decreased the rate of infection. The mean dimension of the wound before vacuum-assisted closure therapy was 66.05 cm and the mean dimension of the wound after vacuum-assisted closure therapy was 27.97 cm. The difference in the mean before and after the intervention was statistically significant according to the paired t-test (p < 0.001). Hence, vacuum-assisted closure dressing helped decrease the wound size which was proven statistically. Conclusions Vacuum-assisted closure is a viable and beneficial treatment option for complicated fractures with large soft-tissue abnormalities.
背景 开放性骨折是常见且严重的损伤，主要影响年轻男性。在过去十年中，骨折治疗方法有所改进。然而，感染及其并发症仍然令人担忧，尤其是在开放性骨折中对受伤区域进行一期缝合时。一种名为负压辅助治疗的新技术已成为许多骨科医生的首选治疗方法。本研究旨在确定负压辅助闭合是否能缩短肢体 Gustilo-Anderson IIIA/IIIB 型骨折固定后伤口愈合的时间并降低感染频率。
方法 对 2019 年 12 月至 2021 年 7 月期间在科拉尔 RL 贾拉帕医院骨科就诊的 34 例肢体 Gustilo-Anderson IIIA/IIIB 型骨折患者进行了一项观察性分析研究。骨折固定后采用负压伤口治疗进行伤口闭合。对患者进行了为期一个月的随访。
结果 患者的平均年龄为 37.06 ± 10.340 岁。负压辅助闭合敷料前感染发生率为 80.6%，负压辅助闭合敷料后感染发生率为 19.4%。根据 McNemar 检验，干预前后比例的差异具有统计学意义（p < 0.001）。因此，负压辅助闭合敷料降低了感染率。负压辅助闭合治疗前伤口的平均尺寸为 66.05 cm，负压辅助闭合治疗后伤口的平均尺寸为 27.97 cm。根据配对 t 检验，干预前后的平均值差异具有统计学意义（p < 0.001）。因此，负压辅助闭合敷料有助于减小伤口大小，这在统计学上得到了证实。
结论 对于伴有大面积软组织异常的复杂骨折，负压辅助闭合是一种可行且有益的治疗选择。
