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Med J Armed Forces India. 2017 Oct;73(4):321-327. doi: 10.1016/j.mjafi.2016.06.002. Epub 2016 Jul 26.

Negative pressure wound therapy in the management of mine blast injuries of lower limbs: Lessons learnt at a tertiary care center.

Author information

1
Senior Advisor (Surgery) & Reconstructive Surgeon, Command Hospital (Southern Command), Pune 411040, India.
2
Senior Consultant (Surgery), O/o DGAFMS, New Delhi 11000, India.
3
Consultant (Plastic Surgeon), Brij Lal Hospital, Haldwani, Uttrakhand, India.

Abstract

Background:

Mine blast injuries of foot are devastating injuries that result in composite tissue loss or amputations. Negative pressure wound therapy has helped in the management of such combat-related wounds. The aim of this study was to report experiences gained in managing such injuries at a tertiary care center.

Methods:

17 combatants who sustained mine blast injuries were included in this study. Severity of foot injury was assessed as per Foot and Ankle Severity Score. After wound debridement, negative pressure wound therapy was started and foot defect was appropriately reconstructed. Following wound healing, the foot was assessed for Foot and Ankle Severity Score in terms of impairment. The patients were then suitably rehabilitated by shoe modifications, orthosis, or custom-made prosthesis.

Results:

Mean age of soldiers who sustained mine blast injuries was 30.2 years. The mean Foot and Ankle Severity Score was 3.76. Temporary wound closure was achieved using negative pressure wound therapy and it prevented local and systemic infection. The defect could be reconstructed appropriately using split skin graft, regional fasciocutaneous flap, or microvascular free flap. Mean time to definitive reconstructive procedure was 16.5 days. Mean Foot and Ankle Severity Score in terms of impairment was 4.11. All soldiers could be rehabilitated and were returned to their respective units and were able to perform sedentary duties assigned to them.

Conclusion:

The negative pressure wound therapy was helpful in preventing proximal amputations due to mine blast injury and was helpful in satisfactory reconstruction of foot defects.

KEYWORDS:

Delayed reconstruction; Foot defects; Mine blast injuries; Negative pressure wound therapy; Prosthetic rehabilitation

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