The surgical care of modern combatants involves treatment of massive extremity
wounds from blast mechanism. Currently up to 70% of combat
wounds are extremity related. Clinical outcomes for these patients are dependent on the care of these
wounds. The
Vacuum-Assisted Closure (VAC)
Therapy system (KCI Inc, San Antonio, Texas) is ubiquitous in theater and is often considered the only way to treat these
wounds. However, the VAC
Therapy system is not without problems. It is expensive and requires extensive amounts of product and machinery, as well as functioning suction, and therefore a
power source at all times. In addition, the VAC
Therapy system requires a trained and vigilant nursing staff. We hypothesized that the
antibiotic bead pouch would be a viable alternative to the VAC
Therapy system for such
blast injuries. We retrospectively analyzed 2 matched groups of 12 patients in terms of outcome and cost. We found that the VAC
Therapy system produced more late methicillin-resistant Staphylococcus aureus
infections (30%), more unanticipated returns to the operating room for
wound problems (4:12 vs 0:12), and required more surgeries overall until closure of the
wounds. In addition, the VAC
Therapy system cost $12,000 more for 12 patients than the
antibiotic bead pouch. We recommend the bead pouch be considered as an equivalent option to the VAC
Therapy system in the treatment of
blast injury.