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Comparative Study
. 2011 Dec;8(6):599-607.
doi: 10.1111/j.1742-481X.2011.00835.x. Epub 2011 Aug 19.

Use of vacuum-assisted closure (VAC™) in high-energy complicated perineal injuries: analysis of nine cases

Mustafa Tahir Ozer  1 , Ali Kagan Coskun, Ismail Hakki Ozerhan, Nail Ersoz, Ramazan Yildiz, Huseyin Sinan, Sezai Demirbas, Orhan Kozak, Ali Ihsan Uzar, Sadettin Cetiner
Affiliations
Comparative Study

Use of vacuum-assisted closure (VAC™) in high-energy complicated perineal injuries: analysis of nine cases

Mustafa Tahir Ozer et al. Int Wound J. 2011 Dec.

Abstract

Our study reviewed nine patients who were treated with the VAC™ Abdominal Dressing System after suffering pelvic fractures and soft tissue loss after high-energy pelvic trauma. Between March 2008 and August 2009, our clinic treated nine patients with complicated perineal injuries from high-energy pelvic trauma with multiple irrigation and debridement procedures and broad-spectrum antibiotics. Protective ostomies were created for all nine patients. Required interventions were made for associated injuries, and VAC™ application was started. All patients were male, with an average age of 24·3 (range 21-32) years, and a mean injury severity score of 36·4 (range 16-59). Wound diameters ranged from 15 to 30 cm, and wound depths ranged from 5 to 25 cm. The injuries included one traumatic bilateral hemipelvectomy, and three unilateral and two bilateral lower extremity amputations. Intensive care unit length of stay averaged 12 (6-19) days, and average hospital length of stay was 44·12 (31-64) days. Beginning at an average of day 17 (±5·9 days) post-injury, wound cultures detected no bacterial colonisation. One patient died on the sixth day after injury from septic complications. Two patients' wounds were closed by primary closure, and six patients' wounds were closed by split thickness grafts after an average of 31·4 (17-50) days. Optimal treatment of high-energy perineal injuries requires early and extensive debridement and rich irrigation. The application of the VAC™ system as temporary coverage of large complex wounds in the pelvic region enhances wound healing and facilitates an early grafting process.

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Figures

Figure 1
Figure 1
Open wound.
Figure 2
Figure 2
Open wound different view.
Figure 3
Figure 3
Applicated VAC.
Figure 4
Figure 4
Approximation sutures (above), graft application (below).
Figure 5
Figure 5
Injured sphincters (left), VAC Application (right).
Figure 6
Figure 6
Anal region after VAC application.
Figure 7
Figure 7
The last view of the same patient.
See this image and copyright information in PMC

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