SLR - October 2009 - Blair James Sandall
Reference:
Lee., H.., Kim, J., Oh, C., Min, W., Shon, O, et al. (2009). Negative pressure wound therapy for soft tissue injuries around the foot and ankle. Journal of Orthopaedic Surgery and Research, 4(14).
Scientific Literature Review
Reviewed by: Blair James Sandall, DPM
Residency Program: VA-Southern Arizona Health Care System
Podiatric Relevance:
This study evaluates granulation tissue formation with the use of negative pressure wound therapy (NPWT) in bone and or tendon exposed wounds about the foot and ankle. NPWT is a treatment option used often, but the article questions its application in the area of the foot and ankle for the formation of granulation tissue. If there is a less painful or less frequent and disruptive treatment option for the difficult to manage wounds that have bone or tendon exposed about the ankle, it is worth the attention.
Methods:
A prospective study of 16 patients (4 female) was performed over a 4 year period (2003-2006 with a mean follow-up of 19 months) treating soft tissue injuries of the foot and ankle with NPWT (V.A.C, Vacuum Assisted Closure, KCI, San Antonio, United States). The mean age at the time of the study was 32.8 years and ranged from 3-67 years. Twelve wounds were on the dorsum of the foot, 3 on the medial side of the ankle, and 1 on the lateral ankle. Twelve injuries were caused in traffic accidents, 2 from crush injuries and another 2 during a fall from a height. All wounds had at least one bone or tendon exposed, and 4 had associated infections.
The dressings were changed every 3-4 days at bedside and the patient was taken into the operating room for further debridement if needed. The therapy was left on continuous mode at 100-125 mmHg, and was discontinued when granulation tissue had formed over the deficit. Adjunctive grafting was performed if needed.
Results:
Therapy was performed for a mean of 18.4 days (range of 11-29 days). Fifteen of the 16 patients had complete coverage of bone or tendon upon completion of therapy and went on to split (14 patients) or full (1 patient) thickness skin grafting. One case required free flap grafting. There were no complications as a result of the NPWT.
Conclusion:
Although there are multiple limitations to the study, to the evidence suggests that NPWT may be useful in the treatment of tendon and bone exposed wounds around the foot and ankle. The authors also felt that NPWT shortened healing time and reduced not only the chance of infection, but the need for additional soft tissue reconstruction as well.