Vacuum assisted closure therapy. Management of a severe blast injury to the lower limb

This article reports the case of a 23-year-old woman who sustained severe soft tissue injuries with open fractures of the left distal femur, the left proximal tibia, a subtotal amputation of the left foot with injuries to the anterior and posterior tibial artery due to a bomb blast. When the patient was transferred to our hospital 17 days after the trauma, all primarily closed wounds were severely infected. The fractures were treated by external fixateur and k-wire fixation. After debridement and initiation of negative pressure therapy the anterior tibial artery was reconstructed after 3 days and partial wound closure by a rectus abdominis muscle flap was achieved after 19 days. After almost total wound closure was accomplished open reduction internal fixation (ORIF) was performed for the distal femur fracture and a modification of the external fixateur for the tibial and foot fractures. The negative pressure therapy is an important component for treatment of complex soft tissue injuries and open fractures; however, it must be embedded in an interdisciplinary treatment plan with well-defined treatment goals.