Vacuum-Assisted Closure for the Treatment of Gunshot Wounds

ABSTRACT

-Gunshot wounds are seen too commonly throughout the United States. Shotgun wounds and high-velocity gunshot wounds destroy or remove a wide path of tissue and injure an even wider tract. When nonviable tissue is debrided, a large open wound is often created, posing special reconstructive problems. Viable but exposed bone, tendons, nerves, blood vessels and abdominal and thoracic viscera may be present in the wound. Tissue surrounding these key structures suffers from significant shock-wave injury. This tissue frequently becomes markedly edematous, brawny, and fixed in a retracted position. Edema compromises circulation. Surgical mobilization of this tissue toward the center of the open wound is typically impossible due to the postinjury inelastically of the tissue. Adjacent regional flap closure is frequently unreliable due to the poor circulation in the widely injured surrounding tissue. Removing edema increases circulation and significantly improves tissue elasticity. When edema is removed surrounding a gunshot wound and a simultaneous traction force is placed on all surrounding tissues, a large open wound soon appears much smaller. These principles initiated the development of the vacuum-assisted closure (VAC) device. Unanticipated additional benefits with VAC application were also soon discovered. With improved circulation status postreduction of edema, granulation tissue formed more rapidly. Also bacterial counts dropped below 10⁵organisms per gram of tissue soon after VAC application. Finally, the traction force applied to the wound edges was actually capable of closing wounds by tissue stretching similar to that seen with tissue expansion. Laboratory and clinical experience with the VAC device to date will be highlighted in this perspective. Clinical experience will focus on gunshot wounds.

KEYWORD

Vacuum-assisted closure - gunshot wounds - shotgun wounds