Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 12 , ISSUE 3 ( September-December, 2023 ) > List of Articles


Lower Limb Trauma: Salvage Through Vacuum-assisted Closure in an Ecuadorian Tertiary Hospital

Andrea Villarreal-Juris, Ramiro Villarreal-Juris, Jaime Dyer-Rolando

Keywords : Degloving injuries, Limb salvage, Lower limb, Vacuum-assisted closure

Citation Information : Villarreal-Juris A, Villarreal-Juris R, Dyer-Rolando J. Lower Limb Trauma: Salvage Through Vacuum-assisted Closure in an Ecuadorian Tertiary Hospital. Panam J Trauma Crit Care Emerg Surg 2023; 12 (3):136-143.

DOI: 10.5005/jp-journals-10030-1433

License: CC BY-NC 4.0

Published Online: 30-12-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Introduction: Major trauma causes shear, compressive, and torsional forces to the lower limbs, resulting in complex and devastating soft tissue and bone injuries that challenge the most experienced surgeons. For such injuries, the standard of care is early debridement and coverage, which in recent years has been ubiquitously done using vacuum-assisted closure (VAC). Objective: Describe the short-term outcomes of adult patients with devastating lower limb injuries from January to December 2022 at the Luis Vernaza Hospital in Ecuador. Materials and methods: Observational, retrospective, and analytical study. Data was obtained from electronic medical records and analyzed using Statistical Package for the Social Sciences (SPSS) 27.0. Yan's classification was used. Management was early wound excision and coverage using VAC. Main outcomes—wound healing; limb mobility at 180–190 days; infection; length of stay; days-to-skin graft; and mean total surgical time. Results: A total of 13 patients were included, all male, mean age—31.4 years (20–45 years), mean length of stay—38.9 days (24–65 days). The most common mechanism of injury was motorcycle (58.85%); the left lower limb was the most affected (61.5%); 53.9% of injuries were pattern 2B and 46.1% pattern 3, which increased length of stay (p = 0.004); mean total surgical time (p = 0.349), days-to-skin graft (p = 0.002); and a 4x higher probability of secondary healing [odds ratio (OR)—4.031, p = 0.005]. No significant difference was observed in conventional vs silver-impregnated foam dressings and infection, length of stay, days-to-skin graft, and mean total surgical time. Minor infection significantly increased days-to-skin graft (p = 0.002). All patients had limb mobility by 180–190 days follow-up and none underwent amputation. Conclusion: The VAC appears to be a useful tool in managing catastrophic lower limb injuries (including pattern 3). Early VAC coverage allows early large defect coverage until surgical reconstruction, may reduce infection, and preserve mobility thus aiding limb salvage.

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