The use of the
vacuum-assisted closure device (VAC; KCI, San Antonio, Texas) has given the orthopedist a new tool for the successful management of severe traumatic
wounds and
open fractures. While the VAC's role in the adult population is proving itself as an improved
therapy compared to "traditional
wound care," it's role within pediatric orthopedics remains less well defined. Questions remain whether VAC
therapy provides benefit regarding decreased
infection rates as well as decreased need for extensive soft tissue coverage procedures. A review was therefore performed of a pediatric level I trauma center's experience using the VAC
therapy for pediatric
open fractures with a focus on the rate of superficial, deep, and
chronic infection. A retrospective chart review spanning 4.5 years of all pediatric patients younger than 18 years with an
open fracture initially treated with VAC
therapy was conducted at a level I pediatric trauma center. This yielded 28 patients with 37
open fractures aged 2 to 17 years who were initially treated with
wound VAC
therapy. Subsequent chart review of these patients was performed examining in-hospital records, operative notes, and clinical follow-up visits for documented cases of superficial, deep, or
chronic infection. Of 37 open pediatric fractures treated with a
wound VAC, there were no cases of superficial
infection and 2 cases of deep
infection for an overall
infection rate of 5%. Both
infections resolved with surgical intervention and
antibiotics without
chronic infection development. When compared with historical controls, the use of VAC
therapy for pediatric
open fractures appears to be an equally safe and effective modality to help reduce
infection in pediatric
open fractures and should be considered a valuable tool in treating these
injuries.