Yogesh1 , Sanjeev M. N.2
BACKGROUND A wound is defined as an injury creating a disruption in the normal anatomical structure and function of the skin. There are two different types of wounds: vulnus that is an acute wound, which heals according to the normal wound healing process, and ulcus that is defined as hard-to-heal wounds (previously labelled chronic wounds) such as leg ulcers, pressure ulcers and diabetic foot ulcer. These wounds have a duration of more than six weeks and often show a disturbed wound healing process due to underlying causes other than direct trauma. METHODS This is a prospective study conducted among 40 cases satisfying the inclusion criteria admitted in KIMS, Hubli, from November 2016 to October 2018. Wounds were initially debrided and vacuum assisted dressing applied. Wounds were assessed depending on wound size and score before and after the application of VAC and the number of VAC settings required for uniform healthy granulation tissue formation was noted. RESULTS Among the 40 patients, location of open fracture was 72% in leg, 20% in foot and 8% of wounds were with forearm fractures. 30% of patients had initial wound score of 2a, 12.5% had score 2b, and 57.5% had score of 3. Patients with initial wound score 2 showed average reduction of 12.2 mm with appearance of healthy granulation tissue by average of 9 days and patients with initial wound score 3 showed average reduction of 10.3 mm at the end of VAC treatment with appearance of healthy granulation tissue by mean 10.4 days. The mean reduction in size of the wound overall is 11.25 mm. 20 patients required flap as a definitive closure procedure whereas in 19 patients, wound was closed by split skin grafting. One wound was contracted with VAC treatment. CONCLUSIONS Gustilo Anderson type 3 B open fractures were most commonly caused by road traffic accidents. Males were more prone for injury than females. The most common bone involved in this type of fracture is Tibia. Vacuum assisted closure therapy appears to be a viable adjunct for the treatment of open musculoskeletal injuries. Application of sub atmospheric pressure after the initial debridement to the wounds results in an increase in local functional blood perfusion, an accelerated rate of granulation tissue formation, and decrease in tissue bacterial levels. The granulation tissue formed was healthy and uniform. Soft tissue defects which lead to ugly and irregular surface were avoided by forming uniform granulation tissue and the defects were covered.
