Effective Application and Outcome of Negative Pressure Wound Therapy in Management of Complex Wounds with External Fixator

Background: Negative pressure wound therapy ( NPWT ) has been commonly used in the management of complex traumatic wounds of extremities. It reduces oedema, increases perfusion and enhances granulation tissue formation. But presence of external fixator makes it difficult to apply and maintenance of seal in presence of external fixator thus affecting wound healing. Objective: To study the effective application and outcome of NPWT in the management of complex wounds. Methods: Retrospective study conducted in Department of Plastic and Reconstructive Mayo Hospital/KEMU over a period of 2 years (June20- June 22). All patients presenting with wounds on either upper or lower limb with external fixator applied during this period were included. After wound debridement NPWT was applied according to our technique. Demographic data of patients, mode of injury, time of presentation after injury and site/size of wound were noted. Outcome of seal (Effective maintenance of suction pressure at the completion of NPWT application and Seal failure as loss of suction within 72 hrs ) , no. of NPWT sessions and outcome of wound (skin grafting/flaps) were documented. Results: In this study, total number of patients was 26. Seventeen were (65.4%) males and 9(34.6%) females. Mode of injury was road traffic accident (69.8%) and machine injury (30.8%). Mean age was 23±14.2 years. Mean wound size 31.3±12.6 in2. Mean time of presentation after injury was 11.8±6.14 days. In 3 patients seal was not maintained. In 23 patients seal was maintained. Skin grafting was done in 21 patients and local/ distant flaps in 5 patients. Conclusion: NPWT has been in use for the management of wounds for many years. But problem arises in its application over wounds with external fixator. There are chances of air leakage and difficulty in maintaining seal. With our technique of application, we have been able to manage this problem. It is a simple, quick and inexpensive technique with overall good results. Use of this technique minimizes the use of major local and free flaps for soft tissue coverage of limbs.