J reconstr Microsurg 2017; 33(S 01): S08-S13
DOI: 10.1055/s-0037-1606542
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Role of Negative Pressure Therapy as Damage Control in Soft Tissue Reconstruction for Open Tibial Fractures

Mario Cherubino
1  Department of Biotechnology and Life Sciences, Division of Plastic and Reconstructive Surgery, University of Insubria, Varese, Italy
,
Luigi Valdatta
1  Department of Biotechnology and Life Sciences, Division of Plastic and Reconstructive Surgery, University of Insubria, Varese, Italy
,
Pierluigi Tos
2  Department of Orthopaedics and Traumatology for Hand, ASST Gaetano Pini, Milan, Italy
,
Salvatore D'Arpa
3  Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Gent, Belgium
4  Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
,
Luigi Troisi
5  Department of Plastic and Reconstructive Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
,
Pellegatta Igor
1  Department of Biotechnology and Life Sciences, Division of Plastic and Reconstructive Surgery, University of Insubria, Varese, Italy
,
Federica Corradi
1  Department of Biotechnology and Life Sciences, Division of Plastic and Reconstructive Surgery, University of Insubria, Varese, Italy
,
Umraz Khan
5  Department of Plastic and Reconstructive Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
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Publikationsverlauf

26. Juli 2017

31. Juli 2017

Publikationsdatum:
06. Oktober 2017 (online)

Abstract

The concept of damage control orthopaedics (DCO) is a strategy that focuses on managing orthopaedic injuries in polytrauma patients who are in an unstable physiological state. The concept of DCO is an extension of damage control surgery or damage limitation surgery (DCS/DLS). Recently, it has become clear that certain patients, following extensive soft tissue trauma, could benefit from the idea of DCS. In the management of severe lower extremity trauma with exposed fracture sites, aggressive early wound excision debridement, early internal fixation, and vascularized wound coverage within a few days after trauma were proposed. A negative-pressure dressing can be easily and rapidly applied to obtain a temporary closure between surgical stages. While negative pressure wound therapy (NPWT) has clear indications in the management of chronic wounds, its applications in the acute setting in victims of polytrauma are uneven. We conducted a review of the current clinical literature to evaluate the role of NPWT in this field, which points out that the negative pressure, applied immediately after the first debridement, seems to be an optimal bridge to the final reconstruction up to 7 days.