Management of lower extremity traumatic injuries with negative pressure wound therapy: Experience of a pediatric plastic surgery department.

Introduction: Extensive lower limb traumatic injuries are particularly challenging when they associate skin and soft tissue defects, moreover when the patient is a child. In view of more frequent recommendations and reports of negative pressure wound therapy (NPWT) use for severe trauma and extensive soft tissue defects of the lower extremity, we aimed at reviewing the indications and outcomes of this technique in our pediatric plastic surgery department.

Method: We performed a retrospective study for the period 2016-2019, in order to identify patients having suffered injuries of the ankle and foot, for who NPWT was used in the therapeutic protocol.

Results: For the study period we identified a total of 9 children with ankle and foot injuries who had NPWT in their therapeutic protocol. The average age was 10 years (range 3 years 5 months to 14 years 4 months) and 8 of them were pedestrians, victims of traffic accidents. Five patients presented with associated injuries and fractures in other anatomic locations. NPWT was started 1-3 days after admission and it was used in average for 21.77 days, with good results in all cases. For 8 patients NPWT was sufficient to contract the wound and cover exposed bone and tendons before closing with split thickness skin graft (STSG). One patient needed also a free muscular flap transfer before grafting. All patients achieved complete healing and started physical therapy before discharging.

Conclusion: NPWT has proven to be an easy to use, safe and effective therapeutic tool for pediatric patients, with considerable improvement for healing in case of traumatic injuries of foot and ankle, presenting extensive skin and soft tissue defects and bone exposure in children. NPWT is also suitable for children since its use implies less frequent dressing changes, and decreases the level of pain and anxiety, and spares donor areas needed for more complicated procedures and, by creating an optimal grafting bed, it ensures good outcomes, in the short term and long term as well.