Wednesday, November 6, 2002
1041

Treatment of Traumatic Hand/Upper Extremity Wounds with the V.A.C. Wound Healing Device

Anthony J DeFranzo, MD, Louis C. Argenta, MD, Lisa R. David, MD, Malcolm W. Marks, MD, Joseph Molnar, MD. PhD, David Ruch, MD, Claire Sanger, MD, and Michael J. Morykwas, PhD.

Traumatic injuries to the hand are fraught with significant morbidity. Protracted recovery and multiple operations are the usual rule in these patients. We report 48 patients with isolated trauma of the hand who were treated with the Vacuum Assisted Closure device. All wounds were initially grossly contaminated. There were 37 males and 11 females. Nine patients had crush injuries. Nine patients had degloving injuries. Four patients had thermal burns and three had electrical burns. Three patients had gunshot injuries. The remaining 20 patients had a variety of assorted other injuries (saw, chainsaw, lawnmower, etc.). Sixteen of the patients presented with exposed bone and seventeen had exposed tendon. All patient's wounds were debrided of necrotic tissue and foreign particles, the VAC dressing applied, and the dressings changed at forty eight hour intervals. Subsequent debridements were performed as needed. The mean (+/- standard deviation) of VAC treatment was 6.0 +/- 3.9 days. The mean length of stay (+/- SD) was 11.2 +/- 7.3 days. Abundant granulation tissue over any exposed underlying structures (bone/tendon/joint) allowed coverage with split thickness skin grafts in twenty patients and full thickness skin grafts in three patients. Eight patients underwent local flap closure. Nine wounds were closed primarily. The remaining eight wounds closed spontaneously, usually with wet-to-moist dressing changes. There was no loss of any extremity in this series. No patient has required further surgery for either breakdown or secondary infection. Use of the Vacuum Assisted Closure device offers a significant advantage in treating these contaminated traumatized wounds. Local control of edema and infection is achieved and closure obtained with minimal intervention. Long term results have been gratifying.
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