COMPLEX FOOT INJURY TREATMENT USING VACUUM ASSISTED CLOSURE AND PLATELET-RICH FIBRIN METHOD – CASE REPORT
Abstract
Introduction: Traffic accidents are one of the leading causes of death and injuries worldwide. According to the World Health Organization (WHO), more than 1.3 million people die annually in road accidents, while between 20 and 50 million suffer injuries. The majority of these injuries involve limb trauma, with the lower limbs being most commonly affected, particularly among pedestrians and motorcyclists.
Case report: This report presents the case of a 77-year-old female pedestrian involved in a road accident, sustaining open fractures of the second and third metatarsal bones of the left foot (Gustilo type II). Initial surgical treatment was performed immediately after the injury, including extensive irrigation, debridement, and fracture stabilization using K-wires, along with below-knee plaster immobilization and triple antibiotic therapy. Further complex treatment involved a combination of vacuum-assisted closure (V.A.C.), platelet-rich fibrin (PRF) application, and hyperbaric oxygen therapy (HBO).
Conclusion: Timely surgical intervention was crucial for achieving a positive outcome in an elderly patient, ensuring healing without infection and functional recovery. A multidisciplinary approach was essential in this complex case, adapting therapy to the specific needs of an elderly patient and improving overall recovery.
References
World Health Organization. Global status report on road safety 2018 [Internet]. Geneva: World Health Organization; 2018 [cited 2025 February 24]. Available from: https://www.who.int/publications/i/item/9789241565684
Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006 Aug;37(8):691-7. doi: 10.1016/j.injury.2006.04.130.
Kirley BB, Robison KL, Goodwin AH, Harmon KJ, O’Brien NP, West A, et al. Countermeasures that work: a highway safety countermeasure guide for State Highway Safety Offices, 11th edition, 2023 [Internet]. Washington (DC): National Highway Traffic Safety Administration; 2023 Nov. Report No.: DOT HS 813 490. Available from: https://www.nhtsa.gov/book/countermeasures-that-work/pedestrian-safety
Zohrevandi B, Rad EH, Kouchakinejad-Eramsadati L, Imani G, Pourheravi I, Khodadadi-Hassankiadeh N. Epidemiology of head injuries in pedestrian-motor vehicle accidents. Sci Rep. 2023 Nov 20;13(1):20249. doi: 10.1038/s41598-023-47476-z.
Engel P, Ranieri M, Felthaus O, Geis S, Haubner F, Aung T, et al. Effect of HBO therapy on adipose-derived stem cells, fibroblasts and co-cultures: in vitro study of oxidative stress, angiogenic potential and production of pro-inflammatory growth factors in co-cultures. Clin Hemorheol Microcirc. 2020;76(4):459-71. doi: 10.3233/CH-209222.
Roses M, Bonvehí PE. Vaccines in adults. Medicina (B Aires). 2019;79 (Spec 6/1):552-58. English.
Khan AA, Khan IM, Nguyen PP, Lo E, Chahadeh H, Cerniglia M, et al. Skin graft techniques. Clin Podiatr Med Surg. 2020 Oct;37(4):821-35. doi: 10.1016/j.cpm.2020.07.007.
Chloros GD, Kakos CD, Tastsidis IK, Giannoudis VP, Panteli M, Giannoudis PV. Fifth metatarsal fractures: an update on management, complications, and outcomes. EFORT Open Rev. 2022 Jan 11;7(1):13-25. doi: 10.1530/EOR-21-0025.
Ayoglu N, Afacan MY, Ozsahin MK, Seker A. Match the metatarsal heads: a case of all-metatarsal fractures after a motorcycle accident. Cureus. 2023 May 29;15(5):e39659. doi: 10.7759/cureus.39659.
Omar M, Zeckey C, Krettek C, Graulich T. Offene Frakturen [Open fractures]. Unfallchirurg. 2021 Aug;124(8):651-65. German. doi: 10.1007/s00113-021-01042-2.
Kremer M, Burkemper N. Aging skin and wound healing. Clin Geriatr Med. 2024 Feb;40(1):1-10. doi: 10.1016/j.cger.2023.06.001.
Ratner D. Skin grafting. From here to there. Dermatol Clin. 1998 Jan;16(1):75-90. doi: 10.1016/s0733-8635(05)70488-5.
Klakeel M, Kowalske K. The role of hyperbaric oxygen therapy for the treatment of wounds. Phys Med Rehabil Clin N Am. 2022 Nov;33(4):823-32. doi: 10.1016/j.pmr.2022.06.008.
Normandin S, Safran T, Winocour S, Chu CK, Vorstenbosch J, Murphy AM, et al. Negative pressure wound therapy: mechanism of action and clinical applications. Semin Plast Surg. 2021 Aug;35(3):164-70. doi:10.1055/s-0041-1731792.
Yane Y, Hida J, Makutani Y, Ushijima H, Yoshioka Y, Iwamoto M, et al. The technique for less infectious and earlier healing of stoma closure wound: negative pressure wound therapy with instillation and dwelling followed by primary closure. BMC Surg. 2021 Mar 22;21(1):157. doi:10.1186/s12893-021-01109-2.
Grecu AF, Reclaru L, Ardelean LC, Nica O, Ciucă EM, Ciurea ME. Platelet-rich fibrin and its emerging therapeutic benefits for musculoskeletal injury treatment. Medicina (Kaunas). 2019 May 15;55(5):141. doi: 10.3390/medicina55050141.
Cianforlini M, Mattioli-Belmonte M, Manzotti S, Chiurazzi E, Piani M, Orlando F, et al. Effect of platelet rich plasma concentration on skeletal muscle regeneration: an experimental study. J Biol Regul Homeost Agents. 2015 Oct-Dec;29(4 Suppl):47-55.
Miron RJ, Gruber R, Farshidfar N, Sculean A, Zhang Y. Ten years of injectable platelet-rich fibrin. Periodontol 2000. 2024 Feb;94(1):92-113. doi: 10.1111/prd.12538.
Simonpieri A, Del Corso M, Vervelle A, Jimbo R, Inchingolo F, Sammartino G, et al. Current knowledge and perspectives for the use of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in oral and maxillofacial surgery part 2: Bone graft, implant and reconstructive surgery. Curr Pharm Biotechnol. 2012 Jun;13(7):1231-56. doi: 10.2174/138920112800624472.
Davis KE, La Fontaine J, Farrar D, Oz OK, Crisologo PA, Berriman S, et al. Randomized clinical study to compare negative pressure wound therapy with simultaneous saline irrigation and traditional negative pressure wound therapy for complex foot infections. Wound Repair Regen. 2020 Jan;28(1):97-104. doi: 10.1111/wrr.12741.
Vellingiri K, S NJ, Hongaiah D. Negative pressure wound therapy with flap reconstruction for extensive soft tissue loss in the foot: a case report. Cureus. 2020 Aug 29;12(8):e10116. doi: 10.7759/cureus.10116.
