A Case Report: How to Care for Open Lower Leg Fractures with Severe Soft Tissue Damage in the Republic of Korea

Purpose
This paper is a case report which is describes the current evidence about the treatment in open lower leg fractures with severe soft tissue damage and also to formulate recommendations for clinical practice and research.
Background
Provision of soft-tissue coverage for defects in the distal leg and foot is very important, especially in patients with multiple exposed bone or tendon and major soft-tissue defects. Open lower leg fractures are frequently followed by osteomyelitis. The goal of all procedures is to prevent or minimize amputation. Lower-extremity wounds present a difficult treatment challenge.
 It is a daily challenge for healthcare professionals to maintain wound healing in patients with open lower leg fractures.
Methods

Three patients with lower-extremity wounds, which were the result of trauma, were selected for this case report. In this series of patients, vacuum-assisted closure therapy was applied to such lower-extremity wounds. Continuous suction pressure (125 mmHg) was applied to the wound site. The wounds were inspected and the dressings were changed every 48 hours. Vacuum-assisted closure therapy greatly reduced the amount of tissue edema, diminishing the circumference of the extremity and thus decreasing the surface area of the wound. Profuse granulation tissue formed rapidly. The wounds were closed primarily and covered with skin grafts, or flaps. There has been no change in infection, amputation, or malunion/nonunion rates. Conclusions

This technique is effective in open fractures. The possible reasons for this change are a better understanding of the lower leg vascular anatomy and better use of improved wound care technology. We therefore recommend a staged protocol for the treatment of open lower leg fractures with severe soft tissue damage.WOCN, orthopedics, rehabilitation medicine and ward nurses participated in the care for open lower leg fractures. Through the concerted efforts of all who are providing care to the patient, more optimal outcomes will be achieved.