Effect of Vacuum Assisted Closure Therapy in Orthopaedic Trauma to Reduce Post-Operative Infection in Lower Limb Compound Fractures

Abstract

Abstract Background: Patients with road traffic accidents, industrial incidents, falls, or firearm injuries often experience severe polytrauma or orthopedic injuries resulting in compound fractures and grievous soft-tissue injuries, representing a complex clinical situation. The standard treatment of compound orthopedic injuries includes debridement, irrigation, dressing, and antibiotic therapy to control infection, which may or may not require plastic reconstruction procedures once granulation tissue has sufficiently formed. The application of vacuum-assisted closure (VAC) therapy removes local dead space, decreases tissue edema, and promotes granulation tissue formation. VAC shows potential as a novel treatment approach for individuals experiencing severe open fractures following high-energy trauma. This study aimed to compare the postoperative infection rates between VAC and conventional dressing methods in lower-limb compound fractures. Materials and Methods: This study was conducted in the Department of Orthopedic Surgery in King George Medical University, Lucknow, from January 2023 to January 2024, with sample size of 38 patients. Patients were divided into an experimental group (n = 20) and a control group (n = 18) based on the treatment started During VAC application, the wound area was covered with foam and gauze, then an adhesive film was placed over the foam and dressing to seal it. A drainage tube was connected through the foam to a portable vacuum pump. When the pump was turned on, exudate fluid was drawn through the foam and out the drainage tubing into a container. The dressing maintenance time was 5–7 days. As the treatment progressed, serum C-reactive protein and total leukocyte count levels were measured on days 3 and 7, respectively, to study the post-operative infection. Results and Conclusion: There was a statically significant difference between the treatment group compared to the control group in terms of hospital stay, wound healing time, and post-operative infection. In conclusion, VAC dressing in the management of compound fracture reduces the frequency of dressing changes, decreases hospital stay, enhances wound healing, and reduces post-operative infection. Therefore, VAC dressing is a valuable modality as an adjuvant in the treatment of compound fractures in clinical practice.