Comparing Vacuum-assisted Closure To Conventional Dressing Therapy For Soft Tissue Defect In The Limb

Background and objectivesThe different kinds of soft tissue defects in the limb can cause a lot of clinical problems which are very difficult to solve.The situation will turn more complicated when the wounds are infected or underlying structures such as tendon or bone.For decades of years the therapy to this situation is to treat the wounds after debridment to gain a proliferation of granulation tissue,and then close the wounds with skin grafts. It is almost unavoidable patients will suffer at the time of dressing change which may frequently performed.The leakage of fluid and wound odor also make the patient very painful and inconvenient.Meanwhile the doctors in charge of those patients have to spend a lot of time in changing the gauze daily.What's more,there are some other disadvantages,such as slow growth of granulation tissue,too much infective liquid and easy to infect.In the past 20 years many new treatment modalities appeared in order to improve the situation including vacuum-assisted closure technique.In 1992 Fleischmann first described the concept of using controlled sub-atmospheric pressure to treat open or infected wounds.In 1997 The VAC was first investigated by Argenta and Morykwas.After that many laboratory and clinical researches have been performed.In those studies,vacuum assisted closure technique is proved that it can make the wound bed clearer by continuous suction to remove the necrotic tissue and infective liquid,increase the local blood flow of wounds and also stimulate the growth of granulation tissue,decrease bacterial count,increase factors which are benefited to wound healing.So far it had been commonly used in many departments like orthopedics,general surgery,and plastic surgery.Vacuum-assisted closure uses medical grade open cell polyurethane ether foam or polyvinyl alcohol foams as a dressing.The pore size is generally 400-600μm thought optimal for tissue growth.An anti-press evacuation tube with side ports, which communicate with the reticulated foam,is embedded in it.The foam is sealed by tips which can protect the wound against contamination,the aim of the reticulation being that the negative pressure will be applied equally to the entire wound bed.The evacuation tube is connected to an adjustable vacuum pump and which can be adjusted in magnitude of the vacuum effect.In general it is about 125mmHg which is proved to be most suitable for wound healing.We perform a clinical observation to compare vacuum-assisted closure and conventional dressing therapy in soft tissue defects in the limb,to test the effect and find the disadvantage of vacuum-assisted closure.Materials and MethodsFrom April 2008 to February 2009,a total of 46 patients with a soft tissue defects in the limb was treated and followed up in our department.26 patients underwent vacuum-assisted closure therapy and 20 patients were treated by traditional conventional dressing therapy.All patients were followed up for 1-6 months.We recorded and made a contradistinction of each patient's measurements of wound surface area before and 1 week after the treatment,,effectiveness of reconstruction with skin grafts,different kinds of complications encountered,their complain and satisfaction,money they spent,and the time of treatment.Result 1.In deal with the wounds underlying structures such as tendon or bone, vacuum-assisted closure gains obvious advantage over conventional dressing therapy(P = 0.004).2.In the period of 1 week after the treatment vacuum-assisted closure can be more benefited to wound healing than conventional dressing therapy(t=-3.533,P=0.001), their healing rate are 9.6%±2.7%and 5.5%±1.4%.3.In this study,the effectiveness of two groups of reconstruction with skin grafts is insignificant(U=259.00,P=0.98).4.Vacuum-assisted closure leads to fewer complications encountered than conventional dressing therapy(χ~2=3.93,P=0.047),but 2 patients lose more than 500ml blood in 1 hour after the operations possibly because of blood vessel.5.Patients feel less painful and are more satisfied in vacuum-assisted closure therapy(t=-5.163,P＜0.01),their McGill scores are 3.04±1.59 and 5.85±2.11.6.Analyzing the amounts of the money they spend on the total of dressing (4342.5±1908.2 and 738.2±407.4 Yuan) and all treatment in hospital (22930.4±9049.1 and 18521.8±7658.2 Yuan),vacuum-assisted closure is more expensive than conventional dressing therapy(t=9.358,P＜0.01),but on all treatment in hospital is insignificant(t=1.749,P=0.087)7.The patients who receive conventional dressing therapy spent more time in hospital than those who receive vacuum-assisted closure therapy(20.5±4.4 and 25.7±6.7days),the difference is significant(t=-3.118,P=0.003).ConclusionIn this clinical observation we demonstrate that the use of vacuum-assisted closure therapy and conventional dressing therapy in soft tissue defects in the limb. We recorded and made a contradistinction of each patient's measurements of wound surface area before and 1 week after the treatment,effectiveness of reconstruction with skin grafts,different kinds of complications encountered,their complain and satisfaction,money they spent,and the time of treatment.The study results in that vacuum-assisted closure therapy improved wound healing compared to conventional dressing therapy particularly to deal with the wounds underlying structures such as tendon or bone.Vacuum-assisted closure therapy is a convenient and effective treatment in treating soft tissue defect in the limb.Significant results are also found in complications appeared,their complain and satisfaction,money they spent,and the time of treatment.