Abstract
Background The management of complex soft tissue defects with exposed bones/tendons is always
a challenging task for the surgeon and the problem becomes more pronounced when it
comes to the management of these wounds in children. Though flap procedures are considered
the standard for managing the complex soft tissue defects with exposed bones/tendons
yet small blood vessels for anastomosis, long operative period, increased chances
of perioperative thrombosis, and difficult perioperative management in children add
to the difficulty in performing flap procedures in children. The vacuum-assisted closure
(VAC) therapy has emerged as a novel modality for the management of the difficult
wounds with added advantages, especially in children.
Objective To evaluate the efficacy of VAC in the management of wounds with exposed bones/tendons
in children.
Patients and Method Forty-six children of complex wounds with exposed bones/tendons were included in
the study from July 2016 to June 2018.
Results Out of 46 patients, 31 were male; the patients had a mean age of 8.4 years. Road
traffic accident was the most common mode of injury (54%), with most of the wounds
located over extremities. The mean duration of VAC therapy was 12 days. More than
90% coverage of the exposed structure was seen in 89% of patients. The wounds were
definitively managed by split-thickness skin graft in 89% of patients and flap cover
in 6.5% of patients. The mean cost of the VAC therapy at our government run hospital
was 187 Indian rupees per day. No significant major complications were seen during
the treatment.
Conclusion VAC therapy is an efficient, safe, and cost-effective modality of treatment for the
management of complex wounds in the pediatric population.
Keywords
vaccum-assisted closure - VAC - exposed bone - exposed tendon
