The simultaneous exposure of tissue and bone poses specific management challenges. Patients with extended soft tissue damage and high-grade
compound fractures present a demanding clinical challenge, requiring a complex approach and multiple orthopaedic,
plastic, and vascular-reconstructive procedures. Management involves combinations of
wound debridement and closure by secondary intention, use of
vacuum-assisted closure (VAC) devices, and various reconstructive plastic surgery methods. We present three consecutive complicated cases, involving
compound fractures of the lower limb with massive soft tissue damage (Gustilo-Anderson type IIIB) that were managed with
debridement, application of external fixation and VAC device. The mean
wound size was 24 cm in length and 12 cm in width. The aim of treatment was to cover the bone with soft tissue and achieve healing of the fracture without
persistent infection. Wound healing was achieved in all three cases within 30-42 days (mean 34). In one case, the skin graft was applied on day 33. Utilizing this method as part of a multi-directional approach, the VAC system helps the patient recover faster. Moreover, it acts as a feasible and valuable method to treat
compound fractures with massive soft-tissue defects. VAC can replace microsurgical soft-tissue transfer, reduce the risk of
infection and allow salvaging the limb.