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Wound care following injuries (accidents)

Accidents are usually accompanied by soft tissue contusions and crushed limbs. Depending on the extent of the damage to soft tissue, a primary or even secondary result of such accidents may be open injuries to the skin and to such underlying structures as subcutaneous fat tissue, muscles, tendons or bones.

An open wound caused by an accident and surrounded by a bruised skin area may, consequently, be difficult to heal. In most cases there is local damage to the vessels that supply blood to the soft tissue. This means that wound healing may be delayed owing to the fact that a reduction in circulation brings about reduced local oxygen saturation and impedes transport of the necessary wound healing components. If the injury is further aggravated by a bone fracture under the bruised skin area, healing of the bone fracture may, depending on the extent of the accident-related vascular damage, also be adversely impaired.

Special procedure for treating accident-related wounds and bone inflammation

Considerable progress was made in the treatment of accident-related wounds with the introduction of the technique known as negative pressure wound therapy. Before this technique was available or could be introduced, the standard procedure for surgical wound exploration comprised cleaning, application of a disinfectant rinsing agent and, finally, a sterile dressing. The inherent advantage of negative pressure wound therapy is that a traumatic wound, which is normally dressed with a semi-open dressing, is transformed by this system into a semi-closed dressing. One or more sponges, depending on the size of the wound, are inserted into the wound, which is then sealed with a film that is semi-permeable to water vapour. A suction cup connects the film to a pump which creates a vacuum in the wound. This maintains the sterility of the wound by sealing it off from the environment. The negative pressure thus generated causes excess tissue fluid to be drawn off by suction and stimulates local blood circulation to the wound. As a consequence, wound healing can be set in motion and the risk of soft tissue or bone inflammation substantially reduced.

Negative pressure wound therapy with instillation (wound treatment and its further development)

The Department of Traumatology at the University Hospital Zurich is one of the institutions most responsible for research leading to the further development of an innovative form of negative pressure wound therapy. This is known as negative pressure wound therapy with instillation. When this technique is applied, the sponges that are placed in the wound are regularly rinsed during the day with a disinfectant liquid (such as a diluted polyhexanide solution). This provides an effective means of treating wound infections or bone inflammation. The benefit of this technique is that it reduces the time it takes to treat (infected) wounds or bone inflammation and decisively lowers the risk that such inflammation will reoccur.

Lower extremity/polytrauma consultations

Responsible doctors

Gerrolt Nico Jukema, Prof. Dr. med.

Chief Physician/Deputy Head of Department , Department of Traumatology

Specialties: intra-articular fractures of the lower extremity (joint fractures), treatment of chronic bone and soft tissue infections (osteomyelitis), pseudarthrosis / use of Ilizarov technique
Tel. +41 44 255 23 99

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University Hospital Zurich
Department of Traumatology
Disposition
Rämistrasse 100
8091 Zurich

Tel. +41 44 255 27 30