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Sadaf Siddique
Meraj Ahmed
Purushottam Kumar
Vidyapati Choudhary



Background: Management of wounds with exposed bones and tendons is especially a difficult task in the case of children. The flap procedure is preferred by surgeons to treat the soft tissue defect with bones and tendons exposed. However, in the case of children, the thrombosis during the procedure, long duration of surgery, anastomosis of small blood vessels of children, and management of children before the surgery becomes a tough task. The novel procedure of vacuum-assisted closure of difficult is now considered by surgeons to treat children.

Objective: To assess the effectiveness of the vacuum-assisted closure of wounds in children with exposed bone and tendon wounds

Methods: In the period of February-August 2023, there were 92 patients treated for wounds with exposed bones and tendons with vacuum-assisted closure.

 Results: The average of the patients was 8.4 years. 62 children amongst the 92 were male children. 54% of the patients encountered road accidents which caused injury in the extremities. The vacuum-assisted therapy was given on average for 12 days. In 89% of the patients, almost that is 90% of the coverage was observed. However, the wounds still open were managed with flaps in 6.5% and with split skin graft in 89% of patients. The average cost per day for vacuum-assisted therapy was 2250 rupees at Patna Medical College Hospital.

 Conclusion: Vacuum-assisted closure of the wound is an effective yet safe and economical novel method of treating wounds in which bones and tendons are exposed especially in the case of children.

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1. Chariker ME, Gerstle TL, Morrison CS. An algorithmic approach to the use of gauze-based negative-pressure wound therapy as a bridge to closure in pediatric extremity trauma. Plast Recon¬str Surg 2009;123(5):1510–1520
2. Fenn CH, Butler PE. Abdominoplasty wound-healing compli¬cations: assisted closure using foam suction dressing. Br J Plast Surg 2001;54(4):348–351
3. Banwell PE, Téot L. Topical negative pressure (TNP): the evolu¬tion of a novel wound therapy. J Wound Care 2003;12(1):22–28
4. Orgill DP, Manders EK, Sumpio BE, Lee RC, Attinger CE. Mech¬anism of action of vacuum assisted closure: more to learn. J Surg 2009;146:40–51
5. Wiegand C, White R. Microdeformation in wound healing. Wound Repair Regen 2013;21(6):793–799
6. Morykwas MJ, Argenta LC, Shelton-Brown EI. McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 1997;38(6):553–562
7. Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res 1989; ( 238):249–281
8. Mooney JF, III, Argenta LC, Marks MW, Morykwas MJ, DeFranzo AJ. Treatment of soft tissue defects in pediatric patients using the V.A.C. system. Clin Orthop Relat Res 2000; ( 376):26–31
9. DeFranzo AJL, Argenta LC, Marks MW, et al. The use of vac¬uum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone. Plast Reconstr Surg 2001;108(5):1184–1191
10. Mullner T, Mrkonjic L, Kwasny O, Vecsie V. The use of nega¬tive pressure to promote the healing of tissue defects: a clin¬ical trial using the vacuum sealing technique. Br J Plast Surg 1997;50:194–199
11. DeFranzo AJ, Marks MW, Argenta LC, Genecov DG. Vacuum-as¬sisted closure for the treatment of degloving injuries. Plast Reconstr Surg 1999;104(7):2145–2148
12. Helgeson MD, Potter BK, Evans KN, Shawen SB. Bioartificial dermal substitute: a preliminary report on its use for the management of complex combat-related soft tissue wounds. J Orthop Trauma 2007;21(6):394–399
13. Repta R, Ford R, Hoberman L, Rechner B. The use of nega¬tive-pressure therapy and skin grafting in the treatment of soft-tissue defects over the Achilles tendon. Ann Plast Surg 2005;55(4):367–370
14. Eltayeb H, Kassem R. Negative pressure wound therapy in pediatric extremity trauma: a single-institute experience. Egypt J Surg 2017;36:260–264
15. Lee HJ, Kim JW, Oh CW, et al. Negative pressure wound therapy for soft tissue injuries around the foot and ankle. J Orthop Surg Res 2009;4:14
16. Dedmond BT, Kortesis B, Punger K, et al. Subatmospheric pressure dressings in the temporary treatment of soft tissue injuries associated with type III open tibial shaft fractures in children. J Pediatr Orthop 2006;26:728–732
17. Kang GC, Por YC, Tan BK. In vivo tissue engineering over wounds with exposed bone and tendon: autologous der¬mal grafting and vacuum-assisted closure. Ann Plast Surg 2010;65(1):70–73.