An algorithmic approach to the use of gauze-based negative-pressure wound therapy as a bridge to closure in pediatric extremity trauma.

Background: The efficacy of negative-pressure wound therapy as a bridge to definitive closure of traumatic extremity wounds has been demonstrated in adults. Gauze-based negative-pressure wound therapy has been used to facilitate granulation tissue formation and promote closure in a number of wound types. In this study, the authors evaluated the efficacy of gauze-based negative-pressure wound therapy using the Chariker-Jeter technique for pediatric extremity wounds requiring delayed closure.

Methods: A retrospective review was conducted of 24 pediatric patients presenting with extremity injuries involving soft-tissue defects not amenable to immediate primary closure. After initial irrigation, débridement, and antibiotic therapy, negative-pressure wound therapy using the Chariker-Jeter technique was applied and dressings were changed at 48- to 72-hour intervals before secondary closure or primary closure by skin graft, local flaps, or free tissue transfer.

Results: Granulation tissue was noted in all wounds by day 4. The duration of vacuum therapy averaged 10 days in patients whose wounds were closed primarily (n = 19) and 17 days in patients who were allowed to heal by secondary intention (n = 5). Nine patients' wounds were closed with skin grafts and local flaps, eight were closed with local flaps only, and three were closed with free tissue transfer. There was no incidence of skin graft loss or flap failure. Follow-up evaluation of the wounds averaged 24 months, during which no complications were noted.

Conclusions: As a relatively atraumatic wound care technique with few complications, gauze-based negative-pressure wound therapy with the Chariker-Jeter technique provides a highly effective option for temporary soft-tissue management of extremity trauma in pediatric patients.