Outcome Analysis of Vacuum-assisted Closure Therapy in Gustilo–Anderson Grade IIIB Open Fractures – A Study

Abstract Background: Gustilo–Anderson Grade IIIB (GA IIIB) open fractures pose major challenges due to extensive soft tissue damage and high infection risks. Vacuum-assisted closure (VAC) therapy, a type of negative pressure wound therapy, is widely used to enhance healing, reduce infections, and promote bone union. This study evaluates its effectiveness in managing GA IIIB fractures by assessing infection rates, wound healing, hospital stay, and bone union outcomes, especially in the context of its application in resource-limited settings where there is delayed access to reconstructive procedures. Materials and Methods: In this prospective observational study, 42 patients with GA IIIB fractures were treated with VAC therapy after a single surgical debridement. We analyzed infection rates, wound healing progress, and fracture union. Statistical tests ( t -tests, χ², and logistic regression) were conducted using SPSS, with P ≤ 0.05 considered statistically significant. Results: VAC therapy significantly lowered infection rates (9.52%) compared to historical averages (20%–50%). Granulation tissue was formed in 21.52 ± 6.12 days, with larger wounds taking longer time ( P = 0.0029). Complete wound healing occurred in 80.95% of patients, and 71.43% achieved bone union (mean time: 21.86 weeks). Delayed union and nonunion were observed in 11.90% and 16.67% of cases, respectively. Hospital stay averaged 33.1 ± 7.77 days, correlating with wound severity and VAC duration. Conclusion: VAC therapy improves soft tissue healing, reduces infections, and enhances wound readiness for grafting in GA IIIB fractures. Though hospital stays may be prolonged, its benefits in infection control and granulation tissue formation make it a valuable tool in complex fracture management. Our results validate VAC therapy as a vital adjunct in managing GA IIIB fractures, particularly in resource-limited settings. Further research is needed to refine treatment protocols and minimize hospitalization.