Letter to the Editor [Carta]: negative pressure wound therapy in grade IIIB tibial fractures : fewer infections and fewer flap procedures?

Autor: Carlos Eduardo Fagotti de Almeida, Jayme Adriano Farina, João Luis Gil Jorge, Evelyne Gabriela S. C. Marques, Renan Victor Kümpel Schmidt Lima
Rok vydání: 2015
Předmět:
Zdroj: Repositório Institucional da USP (Biblioteca Digital da Produção Intelectual)
Universidade de São Paulo (USP)
instacron:USP
Popis: W e would like to support the interesting conclusions from a systematic review recently presented by Schlatterer and colleagues [1]. Their study addresses treatment for Grade IIIB tibial fractures and points to negative pressure wound therapy as an option that is changing the way many traumatologists think about the treatment of these difficult-to-manage wounds. As Schlatterer and colleagues point out, some clinicians support wound closure or stable muscle flap coverage within 72 hours to limit complications. The authors, however, found evidence to suggest that negative pressure wound therapy can be performed safely beyond 72 hours without increasing the risk of infection. These complex wounds can cause terrible morbidity and constitute a public health problem for many centers [2]. Through the years, researchers have devised a hierarchy of procedures within a hypothetical reconstructive ladder to guide the surgical treatment of wounds. This traditional reconstructive ladder, in its various iterations, subsequently has become a paradigm that helps to inform the choice of closure method across an array of defects. Currently, the increased availability of negative pressure wound therapy has illuminated its key benefits, including faster granulation tissue formation, less periwound edema, decreased closure time, less-frequent dressing changes, control of bacterial proliferation, and potential cost reduction. Although Janis et al. [3] have now incorporated negative pressure wound therapy as a new step in the traditional reconstructive ladder, we are advocating a different approach. In our experience, a descent in the usual reconstructive ladder (that is, from flaps to skin grafts or primary closure) is feasible if neoadjuvant negative pressure wound therapy is applied in the course of treating some complex wounds. This downscaled approach was taken in 106 patients with complex wounds seen between February 2011 and August 2014. All patients were initially subjected to negative pressure wound therapy via VAC system (Kinetic Concepts Inc, San Antonio, TX, USA). In 90 patients whose wounds were measured, the average wound area was 87 cm. (RE: Schlatterer DR, Hirschfeld AG, Webb LX. Negative pressure wound therapy in grade IIIB tibial fractures: Fewer infections and fewer flap procedures? Clin Orthop Relat Res. 2015;473:1802–1811). The authors certify that they, or any member of their immediate families, have no commercial associations (eg, consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. J. A. Farina Jr MD, PhD (&), C. E. F. de Almeida MD, PhD, E. G. S. C. Marques MD, J. L. G. Jorge MD, R. V. K. S. Lima MD Division of Plastic Surgery of Department of Surgery and Anatomy, Ribeirao Preto Medical School of University of Sao Paulo-Brazil, Av. Bandeirantes, 3900 Monte Alegre, Ribeirao Preto, Sao Paulo 14049-900, Brazil e-mail: jafarinajr@fmrp.usp.br Letter to the Editor Published online: 21 August 2015 The Association of Bone and Joint Surgeons1 2015
Databáze: OpenAIRE
Externí odkaz: