[Repair of skin and soft tissue defects of lower limbs with vacuum sealing drainage combined with flaps].

Objective: To explore the feasibility, indications, and effects of vacuum sealing drainage (VSD) combined with flaps for repairing skin and soft tissue defects of lower limbs.

Methods: From June 2006 to November 2009, 15 patients with skin and soft tissue defects of lower limbs were treated with VSD combined with flaps (VSD group, n = 5) and only flaps (non-VSD group, n = 10). In VSD group, there were 3 males and 2 females with an average age of 46 years (range, 32-69 years), including 3 cases of traffic accident injury, 1 case of skin necrosis after amputation, and 1 case of plate exposure after operation. The locations were lower leg in 1 case, ankle in 2 cases, dorsum of foot in 1 case, and forefoot in 1 case. The defect size ranged from 6.5 cm x 6.0 cm to 23.0 cm x 17.0 cm. The disease course ranged from 2 hours to 2 months. In non-VSD group, there were 5 males and 5 females with an average age of 50 years (range, 23-58 years), including 6 cases of traffic accident injury, 1 case of crush injury in earthquake, 1 case of osteomyelitis, and 2 cases of plate exposure after operation. The locations were lower leg in 1 case, ankle in 3 cases, forefeet and dorsum of feet in 4 cases, and heel in 2 cases. The defect size ranged from 4 cm x 4 cm to 20 cm x 12 cm. The disease course ranged from 1 hour to 2 months. There was no significant difference in general data between 2 groups (P > 0.05).

Results: In VSD group, the preoperative hospitalization days, postoperative hospitalization days, and total hospitalization days were (11.8 +/- 9.5), (35.4 +/- 28.3), and (47.2 +/- 35.8) days, respectively; the size of flap was (232.8 +/- 142.0) cm2; and the infection rate after VSD-use was 0. In non-VSD group, the preoperative hospitalization days, postoperative hospitalization days, and total hospitalization days were (25.8 +/- 12.4), (33.9 +/- 28.1), and (59.7 +/- 32.4) days, respectively; the size of flap was (97.3 +/- 93.6) cm2; and the infection rate after 8 to 14 days of regular therapy was 80%. There were significant differences in the preoperative hospitalization days and the size of flap between 2 groups (P < 0.05). All flaps were alive except 3 partial necrosis (1 case in VSD group, 2 cases in non-VSD group). The 3 flaps healed by skin grafting and suturing. The donor sites healed by first intention. All patients were followed up 5-41 months (22.1 months on average). All flaps were good in color, texture, and wear ability.

Conclusion: It is effective to apply VSD combined with proper flap to repair skin and soft tissue defects of lower limbs, which can cut down infection rate, improve blood supply, shorten the preoperative hospitalization days, and facilitate healing, but whether it can shorten the postoperative hospitalization days and total hospitalization days need further research.