Vacuum-Assisted Closure in Complex Hand Trauma: A Review of Benefits, Indications, and Reconstructive Applications

Complex hand trauma represents a major reconstructive challenge because of the frequent association of soft-tissue loss, contamination, edema, exposed tendons, bone, joints, neurovascular structures, and risk of infection. Successful management requires early debridement, infection control, wound bed optimization, skeletal stabilization when needed, and timely soft-tissue coverage. Vacuum-assisted closure (VAC), also known as negative pressure wound therapy (NPWT), has become an important adjunct in the staged management of complex wounds of the hand and upper extremity. Its benefits include exudate control, edema reduction, promotion of granulation tissue, improvement of wound bed quality, reduction of bacterial burden, stabilization of grafts, and facilitation of subsequent flap or skin graft reconstruction. In selected upper-extremity wounds, NPWT may also reduce the need for more complex procedures. Current evidence supports VAC as a safe and effective tool when used as part of a structured reconstructive strategy rather than as a substitute for adequate surgical debridement or definitive coverage. This review summarizes the mechanisms, indications, advantages, limitations, and clinical applications of VAC therapy in complex hand trauma.