Treatment of large area soft tissue defect in children limbs by sequential vacuum-assisted closure and free flaps / 中华显微外科杂志

ABSTRACT

Objective To investigate the operative techniques and clinical significance in the treatment of large area soft tissue defect in children limbs by sequential vacuum-assisted closure and free flaps. Methods Twenty-two cases of children patients, with a range between 3 and 10 years, were treated by sequential vacum-assisted closure (VSD) and free flaps. All the patients suffered from large area soft tissue defect after severe trauma of limbs, with bone, tendon and other deep tissues exposed or partial defected. The wound area varied from 12 cm × 8 cm to 34 cm × 25 cm, and among the wound 9 cases were fresh and the other 13 were necrotizing infection. After strictly cleaned, the wound was covered with VSD according to the condition of the soft tissue defect and its underlying tissue damage. For the patients complicated with unsteady fracture, the fracture was fixed with outside-fixed frame or inside-Kirschner nails. The VSD negative pressure membrane was removed after 5 to 9 days, then the wound was repaired by free flaps grafting in 8 cases and by free flap combined with skin grafting in the other 14 cases. The survival and recovery conditions were followed up after the operation. Results After treatment by VSD, no obvious infection was seen in 22 cases of children patient with large area soft tissue defect complicated by underlying tissue exposure, and granulation tissue surrounding tendons and bone exposure area grew well. The survival rate of the free flaps was 100% whithout vascular crisis.The infection was well controlled, and no fistula tract was seen. The patients were followed up for 6-24 months and the flaps had soft texture and good appearance with satisfactory functional recovery of the affected limbs.Conclusion For pediatric patients with large area soft tissue defect complicated by underlying tissue exposure, after strict debridement, the treatment circle will be obviously shortened by the application of sequential vacuan seding dranage and microsurgical technique, and the success rate of the operation is improved. Therefore, function of the affected limbs in children will be recovered as far as possible.