ABSTRACT
-Gunshot wounds are seen too commonly throughout the United States. Shotgun wounds
and high-velocity gunshot wounds destroy or remove a wide path of tissue and injure
an even wider tract. When nonviable tissue is debrided, a large open wound is often
created, posing special reconstructive problems. Viable but exposed bone, tendons,
nerves, blood vessels and abdominal and thoracic viscera may be present in the wound.
Tissue surrounding these key structures suffers from significant shock-wave injury.
This tissue frequently becomes markedly edematous, brawny, and fixed in a retracted
position. Edema compromises circulation. Surgical mobilization of this tissue toward
the center of the open wound is typically impossible due to the postinjury inelastically
of the tissue. Adjacent regional flap closure is frequently unreliable due to the
poor circulation in the widely injured surrounding tissue. Removing edema increases
circulation and significantly improves tissue elasticity. When edema is removed surrounding
a gunshot wound and a simultaneous traction force is placed on all surrounding tissues,
a large open wound soon appears much smaller. These principles initiated the development
of the vacuum-assisted closure (VAC) device. Unanticipated additional benefits with
VAC application were also soon discovered. With improved circulation status postreduction
of edema, granulation tissue formed more rapidly. Also bacterial counts dropped below
105organisms per gram of tissue soon after VAC application. Finally, the traction force
applied to the wound edges was actually capable of closing wounds by tissue stretching
similar to that seen with tissue expansion. Laboratory and clinical experience with
the VAC device to date will be highlighted in this perspective. Clinical experience
will focus on gunshot wounds.
KEYWORD
Vacuum-assisted closure - gunshot wounds - shotgun wounds
