Use of Vacuum-Assisted Closure and a Dermal Regeneration Template as an Alternative to Flap Reconstruction in Pediatric Grade IIIB Open Lower-Extremity Injuries

Severe degloving injuries to the pediatric lower extremity are difficult to treat, traditionally requiring local or free flaps for coverage. Combining vacuum- assisted closure techniques with a dermal regeneration template is proposed as a means for covering these difficult wounds. We retrospectively reviewed the charts of 7 consecutive patients (age range, 2-12 years) who underwent this treatment. All extremities healed without flap reconstruction or amputation. Mean follow-up was 24.4 months, and mean wound size was 196 cm². There were 2 superficial graft complications, 1 nonunion successfully treated with bone grafting, 2 patients with subsequent bony deformity, and 1 patient who underwent subsequent soft-tissue procedures for equinus contracture. Use of vacuum-assisted closure and a dermal regeneration template has shown good results as a means of successfully managing grade IIIB injuries without performing complicated flap reconstructions.