~ 205 ~ International Journal of Orthopaedics Sciences 2019; 5(3): 205-208 ISSN: 2395-1958 IJOS 2019; 5(3): 205-208 © 2019 IJOS www.orthopaper.com Received: 16-05-2019 Accepted: 20-06-2019 Dr. Shashikant S Gade Associate Professor, Terna Medical College, Nerul, Navi Mumbai, Maharashtra, India Dr. Pramod Bhor Associate Professor, Terna Medical College, Nerul, Navi Mumbai, Maharashtra, India Dr. Arvind J Vatkar Assistant Professor, Dr. D Y Patil Medical College, Nerul, Navi Mumbai, Maharashtra, India Dr. Sachin Kale Professor, Dr. D Y Patil Medical College, Nerul, Navi Mumbai, Maharashtra, India Dr. Gaurav Kanade Assistant Professor, Dr. D Y Patil Medical College, Nerul, Navi Mumbai, Maharashtra, India Correspondence Dr. Pramod Bhor Associate Professor, Terna Medical College, Nerul, Navi Mumbai, Maharashtra, India VAC (Vacuum assisted closure) Therapy with K wire fixation as management protocol in complex compound foot fractures with soft tissue defects Dr. Shashikant S Gade, Dr. Pramod Bhor, Dr. Arvind J Vatkar, Dr Sachin Kale and Dr. Gaurav Kanade DOI: https://doi.org/10.22271/ortho.2019.v5.i3d.1532 Abstract Many patients who sustain high energy compound fractures of lower extremities are riddled with severe contamination of wound with soft tissue loss. This results in deep infections, non unions and in few cases, amputations. We present a case series of 10 cases with compound fractures of foot with severe degloving injury and wound contamination. Treatment entailed through debridement and was with 5 litres of saline along with betadine. Fractures were fixed with K wires and wound was covered with primary VAC application. Male to female ratio was 8:2. Most of the cases were road traffic accidents. The average number of VACs applied were 2.3. 80% cases underwent split skin graft. We conclude that VAC with K wire fixation is an effective and safe treatment in compound fractures of foot with degloving injuries. Keywords: VAC, management protocol, complex compound, soft tissue Introduction High energy road traffic accidents are often associated with complex foot injuries. Such kind of degloving injuries are complicated with soft tissue loss, contamination and comminuted fractures [1] . The eventual outcome of such injuries depends on the extent of soft tissue damage [2] . Staged treatment respecting the traumatized soft tissue envelope is often advisable. Wound care is a prime importance. Vacuum-assisted closure dressing is a prime aspect of management in wound care [3] . Avascular bony fragments and damaged soft tissues provide help for bacterial growth. Healthy soft tissue around fractures helps in their healing [4] . VAC therapy can be implemented in various stages of healing of such soft tissue injuries like initial definitive surgery, intermediate debridement and definitive plastic surgery. Negative vacuum assisted closure technique improves blood flow to local tissue, promotes granulation tissue formation and impedes bacterial growth [5] . Material and Methods We report a case series of 10 cases of compound foot fractures with degloving injuries. Maximum cases were due to road traffic accidents. Only one case was due to fall of heavy object on foot. The male to female ratio was 4:1. The average age of patients was 36.1 years (Range- 24- 52 years). All cases had unilateral limb involvement. After initial ATLS protocol management, the patients were taken for surgery with K wire fixation of foot bones. Metatarsals were fixed with K wires in retrograde fashion. The K wire ends were kept on the proximal plantar surface of foot. Debris and other contamination was scooped and washed with copious amounts of normal saline (10 litres). The wash was added with intermittent betadine and hydrogen peroxide wash. Later the wound was primarily covered with VAC dressing. Patient was started on 3 IV antibiotics namely ceftriaxone 1 gm BD, Metronidazole 400mg TDS and Amikacin 500mg BD. VAC dressings removed every 7 days and debridements were done if required before application of VAC dressing again. The patient was posted for split skin grafting after adequate bone covered with granulation tissue. Skin grafting dressing was done on 5th day and 10th day of grafting. Patients were followed upto 3 months.