Staged wound closure using tension-reducing taping technique with negative pressure wound therapy in lower extremity open fractures: A retrospective review.

Background: In the treatment of lower extremity open fractures Gustilo-Anderson classification types IIIA/IIIB borderline cases, closing open wound under strong tension may lead to wound edge necrosis and the need for soft tissue reconstruction. The purpose of this study is to examine whether staged wound closure using tension-reducing taping with negative pressure wound therapy (NPWT) could prevent wound edge necrosis in borderline type lower extremity open fractures.

Materials and methods: Patients with ⅢA/ⅢB borderline type lower extremity open fractures who were treated at our institution were included. The patients were divided into two groups: those who underwent conventional wound closure (Group 1) and those who underwent staged closure using tension-reducing taping (Group 2). Characteristics of patients and their injuries were compared between the two groups. In addition, the presence or absence of wound edge necrosis after wound closure, soft tissue reconstruction, and wound infection were compared between the two groups.

Results: Twenty-six patients were included in Group 1 and 21 patients were included in Group 2. There were no significant differences in characteristics of patients and their injuries between the two groups. The rate of wound edge necrosis and the need for local flaps were significantly higher in Group 1 (p = 0.002, 0.027). There was no significant difference in infection rates between the two groups (p = 0.495).

Conclusion: For ⅢA/ⅢB borderline type lower extremity open fractures, staged wound closure using tension-reducing taping technique with NPWT can reduce wound edge necrosis and prevent the transition to iatrogenic type ⅢB.