Background: Prevention of infection is a paramount concern after open fracture of the tibia, and previous studies have shown that delay in soft tissue coverage may raise infection rates. Use of Vacuum Assisted Closure (VAC) devices in open fracture wounds has become common. We analyzed whether use of the VAC sponge can allow delay of flap coverage for open tibia fractures without increase in infection rate.

Methods: We identified 39 patients with grade IIIB open fractures from our trauma registry with minimum 1 year follow up. From the medical record we collected information on the time from injury to definitive wound coverage, type of fixation, type of coverage, and demographics. Infection was defined by identifying patients who required surgical debridement.

Results: Patients who underwent definitive coverage within 7 days had a significantly decreased rate of infection (12.5%) compared to patients who had coverage at 7 days or more post injury (54%, p<0.008). Overall infection rate was 29% with routine use of the VAC sponge. Patients who developed infection had a greater mean time to coverage than patients who did not develop infection (8.9 days versus 4.8 days, p< 0.029),

Conclusions: Routine use of the VAC with open tibia fractures is safe and provides a good primary dressing over open wounds. For IIIB tibia fractures, negative pressure wound therapy does not allow delay of soft tissue coverage past seven days without a concomitant elevation in infection rates.
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