The British Association of Plastic Surgeons and British Orthopaedic Association estimate that 70% of Gustilo 3b tibial fractures require flap coverage. Prior to the introduction of vacuum-assisted closure (V.A.C.®) in the late 1990s, options were limited for the treatment of such injuries in selected individuals with medical comorbidity or complex wounds. VAC has now become an important part of our algorithm for soft tissue reconstruction with excellent results, but its role has not yet been defined in common management pathways. The authors present 3 cases, all different in their mechanism of injury, type of injury, and subsequent management, but all had a successful outcome with VAC.
British Orthopaedic Association/British Association of Plastic Surgeons. The management of open tibial fractures. London: British Orthopaedic Association; September 1997.
2.
Gustilo RB, Merkow RL, Templeman D.Current concepts review: the management of open fractures. J Bone Joint Surg [Am]1990;72-A:299-304.
3.
Godina M.Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg1986;78:285-290.
4.
Tornetta P 3rd, Bergman M, Watnik N, Berkowitz G, Steuer J.Treatment of grade-IIIB open tibial fractures: a prospective, randomised comparison of external fixation and non-reamed loaded nailing. J Bone Joint Surg [Br]1994;76-B:13-19.
5.
Gopal S, Giannoudis PV, Murray A, Matthews SJ, Smith RM.The functional outcome of severe, open tibial fractures managed with early fixation and flap coverage. J Bone Joint Surg [Br]2004;86-B:861-867.
6.
Venturi ML, Attinger CE, Mesbahi AN, Hess CL, Graw KS.Mechanisms and clinical applications of the vacuum-assisted closure (VAC) device: a review. Am J Clin Dermatol2005;6(3):185-194.
7.
DeFranzo AJ, Argenta LC, Marks MW, Molnar JA, David LR, Webb LX, et al.The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone. Plast Reconstr Surg2001;108(5):1184-1191.
