Application of vacuum-sealing drainage for early infection in Gustilo III open fractures

Objective To study management of early infection in Gustilo Ⅲ open fractures and explore the effects of region- and layer-wise applications of Vacuum-Sealing Drainage (VSD). Methods Early in-fections in 46 cases of Gustilo Ⅲ open fracture were treated with VSD from December 2006 to January 2008. Of them, 11 cases were type Ⅲ A; 28 type Ⅲ B, and 7 type Ⅲ C. The area of infected wound surface or skin necrosis ranged from 3 cm × 2 cm to 50 cm×35 cm in all the patients who had previously undergone fixation and vessel repair. After they were treated with debridement, change of fracture fixation or position adjustment of outer fixation device, VSD was applied in a region- and layer-wise manner in the inter-muscular space, inter-joint space and the inter-fracture space of the infection region. The sequence and time of tube withdrawal were dependent on tube position and drainage pattern. After fresh granulation tissue grew, 12 cases underwent flap and muscle graft and 34 cases (36 lesions) underwent skin graft or suture to cover the wounds. Three to 6 months after wound healing, retention of former fixation or change to a permanent fracture fixation was de-termined according to the healing condition and the stability of the fixation. Results All the cases ob-tained fine fracture healing and effective control of infection after debridement and VSD. Forty-four cases of skin graft and tissue flap transplantation showed one-time full recovery, and 2 cases of free skin graft still had a small part of wound unhealed after first transplantation but fully recovered after re-transplantation. All pa-tients had normal body temperature and hemogram, no local fistula or pain. Fractures united within 5 to 12 months with fine limb functional recovery. Conclusions Early detection and timely treatment of early infection in Gustilo Ⅲ open fractures may result in preferable prognosis, and region- and layer-wise application of VSD is effective to control the infection. Key words: Fractures, open;  Infection;  Drainage;  Occlusive dressings