Management of traumatic war wounds using vacuum-assisted closure dressings in an austere environment.

OBJECTIVE: The study was undertaken to develop a protocol for the ongoing management of traumatic war wounds in the austere environment of a combat support hospital.

METHOD: A total of 286 surgical procedures were performed by a single orthopaedic surgeon during a 5-month period at a combat support hospital in Iraq. Over 150 procedures were performed on Iraqi soldiers, detainees, and civilians who would receive their definitive care at the combat support hospital, and who would remain as inpatients until their wounds were healed enough for discharge. Initially, all extremity wounds were treated with surgical irrigation and debridement followed by twice daily dressing changes on the wards. As the ward census increased to 75 patients, it became necessary to develop alternate forms of wound management. Field expedient vacuum-assisted closure (VAC) dressings were instituted. These dressings were created with fluffs or prep sponges, suction tubing, Ioband, and portable suction machines. The VAC dressings were left in place for 3 to 4 days and then changed. Traumatic, contaminated, and infected wounds were rapidly debrided and granulation tissue was induced. The portable suction pumps, however, were extremely noisy and failed with continued use. Machines and sponges manufactured by KCI Inc. were purchased. The VAC dressing became an invaluable tool for managing, closing, and preparing wounds for skin grafting. Over 50 traumatic war wounds were treated with the VAC dressing. The clinical courses of 20 of these wounds were carefully documented with digital photography.

RESULTS: Over 50 traumatic war wounds were effectively treated with initial irrigation and debridement, followed by serial application of VAC dressings. VAC dressings rapidly debrided contaminated wounds, reduced edema, decreased wound size, and induced granulation tissue. Wounds were then treated by delayed primary closure, local flap coverage, or skin grafting.

CONCLUSION: An effective protocol utilizing VAC dressings was developed for the expeditious treatment of traumatic war injuries in an austere environment.