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Successful orthopaedic limb salvage with negative pressure wound therapy (NPWT) in a high-grade open fracture

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Successful orthopaedic limb salvage with negative pressure wound therapy (NPWT) in a high-grade open fracture

Ahmad Sukari Halim, Kah Sui, Kian Hua Yeoh, Mohd Sharifudin Bin Said
10 July 2019

High-energy trauma often causes severe soft tissue damage and highgrade open fracture, associated with exposed bone and tendon. Treatment of acute complex traumatic wounds remains a challenge in clinical practice. Early and suitable treatment for open fracture is essential, as an open fracture is associated with a higher risk of infection and complications during treatment. Soft tissue management in an open fracture is equally important as fracture management in orthopaedics. The wound is managed accordingly to the soft tissue reconstruction ladder after fractures are stabilised. Negative pressure wound therapy (NWPT) is one option in soft tissue coverage and usually used in moderate open fracture, grade II and IIIA. It is an affordable and effective dressing technique, which carries a major role in the treatment of complex traumatic wound. As an adjunctive treatment, it is combined with comprehensive surgical exploration and debridement in promoting wound healing. We present a case of successful lower limb salvage using NPWT in a 16-year-old teenager who sustained a huge degloving wound with high-grade open fracture (Gustillo Anderson grade IIIC) and exposed bone and joint, to complete granulation tissue coverage for split skin graft (SSG). Although the treatment course was protracted, the patient escaped from lower limb amputation and psychological stigma that society associates with the loss of a limb. His knee was stiff with fixed flexion, but he obtained a painless and functional lower limb in non-aided ambulation. NPWT dressing saved the patient from second soft tissue surgery (skin flap) and donor site mobility.

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