Application of anterior internal fixation plus vacuum sealing drainage in the treatment of lower limb open fracture with severe soft tissue defect

[Objective]Lower limb open fractures with severe soft tissue defect are often high-energy injuries.It is always combined with serious contamination.This study was aimed to investigate the effectiveness in the treatment of lower limb open fracture with severe soft tissue defect by anterior internal fixation combined with vacuum sealing drainage(VSD). [Method]Fifty-eight patients(M=18,F=13) with severe soft tissue defect and lower limb open fracture were managed from June 2008 to October 2010,and were divided into two groups.Control groups(CG): all patients were treated by debridement,and later internal fixation after the wound healing.VSD group(VSD-G):all patients were treated by anterior internal fixation following debridement,and the wound surface were filled with VSD connected to vacuum bottle.The wounds were closed with secondary suturing,or skin transplantation,or local flap grafting 7 to 21 days later. [Result]CG: The bones of 28 patients healed in 6~18 months(avg=9.8±2.91 months),and the wounds healed in 20~95 ds(46.81±16.80 ds).VSD-G: The bones of 31 patients healed in 4～10 months(avg=6.29±1.88 months),and the wounds healed in 14~33 ds(19.68±5.30 ds).The bones and wonds healing time of VSD-G were statistically significantly shorter than that of CG.The wounds healing time of Gustil IIIA were statistically significantly shorter than that of IIIB,but the bones healing time showed no statistical significant difference. [Conclusion]VSD combined with anterior internal fixation after debridement is a simple and effective treatment method for lower limb open fracture with severe soft tissue defect.It can shorten healing time of wounds,facilitate fracture and reduce the incidence of complications.