Background Following combat-related, extensive soft tissue injury from gunshot wounds or blasts, prolonged duration from injury to full wound closure is associated with infection, increased morbidity and mortality, failure to mobilize, poor functional outcome and increased cost. The purpose of this study was to evaluate a novel treatment enabling early primary closure of combat wounds. Methods This was a retrospective study of 10 soldiers and civilians with extensive combat-related soft tissue limb injuries (5 gunshot wounds, 5 blasts) treated using the TopClosure® Tension Relief System (TRS) with simultaneous administration of regulated oxygen-enriched and irrigation negative pressure-assisted wound therapy (ROINPT) via the Vcare α® device. Results Nine patients were treated during the acute phase of injury and one was treated following removal of a flap due to deep infection 20 years after injury and flap reconstruction. Two patients had upper limb injury and the rest lower limb injury. With the aid of the TRS and/or ROINPT, immediate primary closure during reconstruction was achieved in 6 patients and delayed primary closure in three. Only one patient required a skin graft to close a small area of the wound after most of the wound had been closed by delayed primary closure. Wound closure was achieved within 0–37 days (median: 12.5 days, interquartile range: 2.75–19.75) from injury. Conclusions The TRS is a novel device for effective, early skin stretching and secure wound closure through the application of stress relaxation and mechanical creep, achieving primary closure of large defects using a simplified surgical technique and reducing the need for closure using skin grafts and flaps and the use of tissue expanders. Delivering supplemental oxygen to the wound by ROINPT reverses the reduced oxygen levels inherent in conventional negative pressure-assisted wound therapy, mitigating anaerobic contamination and reducing infection. Irrigation may accelerate the evacuation of infectious material from the wound and provide a novel method for antibiotic administration. The combination of TRS and ROINPT devices allow for early primary closure with improved functionality of combat-related limb injuries.

中文翻译：

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使用专用的张力缓解系统和负压治疗，通过高剂量原位抗生素治疗和氧气输送，最大限度地减少与战斗相关的软组织损伤的治疗复杂性：一项回顾性研究

背景 在枪伤或爆炸造成的与战斗相关的广泛软组织损伤后，从受伤到完全伤口闭合的持续时间延长与感染、发病率和死亡率增加、无法活动、功能结果不佳和成本增加有关。本研究的目的是评估一种能够早期闭合战斗伤口的新型治疗方法。方法 这是一项对 10 名士兵和平民的回顾性研究，他们使用 TopClosure® 张力缓解系统 (TRS) 治疗广泛的与战斗相关的软组织肢体损伤（5 起枪伤，5 起爆炸），同时给予调节的富氧和冲洗负通过 Vcare α® 设备进行压力辅助伤口治疗 (ROINPT)。结果 9例患者在损伤急性期接受治疗，1例患者在损伤20年后因深部感染取出皮瓣并进行皮瓣重建后接受治疗。2例上肢损伤，其余为下肢损伤。在 TRS 和/或 ROINPT 的帮助下，6 名患者在重建期间实现了立即初级闭合，3 名患者延迟了初级闭合。只有一名患者需要皮肤移植物来闭合伤口的一小部分，因为大部分伤口已经通过延迟初次闭合而闭合。伤口闭合在受伤后 0-37 天（中位数：12.5 天，四分位距：2.75-19.75）内完成。结论 TRS 是一种通过应力松弛和机械蠕变实现有效、早期皮肤拉伸和安全伤口闭合的新型装置，使用简化的手术技术实现大缺损的初步闭合，并减少使用皮肤移植物和皮瓣闭合的需要以及组织扩张器的使用。ROINPT 向伤口输送补充氧气可逆转传统负压辅助伤口治疗中固有的氧气水平降低，减轻厌氧菌污染并减少感染。冲洗可以加速感染性物质从伤口的排出，并为抗生素给药提供了一种新方法。TRS 和 ROINPT 设备的组合允许早期主要闭合，并改善与战斗相关的肢体损伤的功能。ROINPT 向伤口输送补充氧气可逆转传统负压辅助伤口治疗中固有的氧气水平降低，减轻厌氧菌污染并减少感染。冲洗可以加速感染性物质从伤口的排出，并为抗生素给药提供了一种新方法。TRS 和 ROINPT 设备的组合允许早期主要闭合，并改善与战斗相关的肢体损伤的功能。ROINPT 向伤口输送补充氧气可逆转传统负压辅助伤口治疗中固有的氧气水平降低，减轻厌氧菌污染并减少感染。冲洗可以加速感染性物质从伤口的排出，并为抗生素给药提供了一种新方法。TRS 和 ROINPT 设备的组合允许早期主要闭合，并改善与战斗相关的肢体损伤的功能。