The limited access dressing for damage control in trauma patients

The leeching effects of the Limited Access Dressing (LAD) effectively controls infection, reduces edema, promotes earlier physiotherapy, and helps to control secondary damage to trauma cases, which results in faster wound bed preparation, reconstruction, and quicker rehabilitation. The following is a case series of 20 consecutive patients treated with LAD without specific controls. In eight cases bone was exposed, in three cases tendon was exposed, in two cases both bone and tendon were exposed, and in one case an injured brachial artery was exposed. Methods. After saline wash, the LAD with intermittent negative pressure was applied (30 minutes negative pressure, 3.5-hour rest period). Wound debridement and physiotherapy were started on day 1 as necessary. Second stage elective procedure was done after healthy granulation tissue had covered exposed tendon, bone, and vessels. A split-thickness skin graft (SSG) was then applied to cover the wound. Results. Excellent graft take (> 99%) was seen in 18 of the 20 cases where skin grafting was done under LAD. The time taken to prepare the wound for resurfacing (after skin grafting) was less than 6 weeks in the majority (16/18) of cases. Post discharge physiotherapy to achieve maximum possible mobilization in upper extremity (10/20) cases was less than 6 weeks in most cases (6/10). The average cost of treatment was Rs. 16071.00 (US $365). Conclusion. LAD is an effective tool for damage control in trauma cases.