Local negative pressure wound therapy in patients with combat limb injuries: one-center experience
Authors: Bubman L. I. , Topolyanskaya S. V. , Molochnikov A. Yu. , Emomadov A. M. , Nechaev A. I. , Khan S. O. , Karpov V. V. , Obolenskyi V. N. , Marchenko I. P. , Lytkina K. A. , Buriev I. M. , Melkonyan G. G. 
Published: October 2024

Objective. To study the effectiveness and safety of negative pressure wound therapy in patients with combat limb injuries.

Material and methods. 248 patients who suffered of combat injuries of lower and/or upper extremities for 4–58 days (mean 15.8 ± 8.6 days) before admission to the hospital were enrolled in a prospective observational trial. All participants were males. Their age ranged from 19 to 59 years (mean 35.6 + 8.3 years). Most often, wounds were localized in the shin (29.3 % of cases) and feet (12.8 %). 27.3 % patients had amputated limbs and 47.4 % – external fixation devices.

Research results. The participants were under observation from 7 to 238 days (mean 60.4 ± 38.1 days). All patients who were included in the trial had the secondary surgical debridement. The average number of surgical interventions reached 5.9 ± 3.5, varying from 1 to 19 times. All patients had vacuum-assisted dressings. The average number of negative pressure wound therapy (NPWT) sessions was 4.7 ± 2.7, varying from 1 to 13 times. The length of hospital stay directly depended on the number of secondary surgical wound treatment (r = 0.63; p < 0.000001), as well as on the number of sessions of vacuum-assisted therapy (r = 0.67; p < 0.000001). Plastic surgery (with free split-thickness perforated skin grafts, local tissues, full-thickness free and non-free flaps) was performed in 119 patients (47.9 %). The median time from the first secondary surgical debridement in the hospital to the surgery was 34 days (Q1–Q3: 21–46 days), from VAC- system installation to plastic surgery – 34 days (Q1–Q3: 21–42 days). During NPWT, the decrease of wound size was registered in 61.4 %. The initial volume of wound surface was, in average, 2250.4 cm3, while at the last measurement it was 829.0 cm3 (p = 0.0002). The initial area of wound surface was 219.0 cm2, while at the last measurement it was 94.0 cm2 (p = 0.00002). By the computed tomography findings (performed in 9 patients), the primary volume of wound cavity was 494 952 mm3, and the final volume was 79064.8 mm3 (p = 0.007). Mature granulation tissue was seen in wounds of 48.1 % of patients, and young granulations – in 42.7 %. Wound cleansing was observed in 66.4 % of patients, marginal epithelization – in 5.4 %. At the initial wound revision, 41 patient had purulent discharge, while at the last one there was none. During the observational period, the following parameters decreased: C-reactive protein – from 43.7 ± 51.9 to 14.7 ± 20.6 mg/l (p < 0.000001; ESR – from 44.5 ± 22.0 to 23.4 ± 16.5 mm/h (p < 0.000001); leukocytes number – from 9.7 ± 3.5 × 109/l to 7.9 ±6.3 × 109/l (p = 0.0001); neutrophils number – from 6.8 ± 3.2 × 109/l to 4.5 ± 1.6 × 109/l (p < 0.000001); percentage of neutrophils – from 68.8 ± 8.0% to 58.8 ± 8.9% (p < 0.000001) and platelet count – from 514.7 ± 201.9 × 109/l to 349.1 ± 114.1 × 109/l (p < 0.000001).

Conclusion. The obtained findings demonstrate the effectiveness of local negative pressure wound therapy in the complex treatment of patients with combat limb injuries. Further research is needed to study NPWT effectiveness and safety in patients with high-energy injuries.