Extended soft tissue damage and high-grade compound fractures need a complex management approach that involves combinations of wound debridement and closure by secondary intention, use of vacuum-assisted closure (VAC) devices, and reconstructive plastic surgery methods.

Angelis and colleagues recently published three consecutive complicated cases that involved compound fractures of the lower limb with massive soft tissue damage (Gustilo-Anderson type IIIB).The patients were managed with debridement, application of external fixation and VAC device. The authors reported that wound healing was achieved in all three cases within 30-42 days (mean 34).

The VAC system assists the patient in faster recovery. It is a practical and valuable method that can be employed to treat compound fractures with massive soft-tissue defects. VAC can replace microsurgical soft-tissue transfer, diminish infection risk and help save the limb.

Source: Angelis S, Apostolopoulos AP, Kosmas L, et al.The Use of Vacuum Closure-assisted Device in the Management of Compound Lower Limb Fractures with Massive Soft Tissue Damage.Cureus. 2019 Jul 9;11(7):e5104.