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Vacuum-assisted closure (VAC) for craniocerebral wounds in severely injured patients: technical note of a damage control procedure
  1. Christophe Joubert1,
  2. A Sellier1,
  3. J-B Morvan2,
  4. N Beucler1,
  5. J Bordes3 and
  6. A Dagain1
  1. 1 Neurosurgery, Military Teaching Hospital Sainte Anne, Toulon Armees, France
  2. 2 Ear, Nose, Throat and Cervicofacial Surgery, Military Teaching Hospital Sainte Anne, Toulon Armees, France
  3. 3 Anesthesiology and Intensive Care Unit, HIA Sainte Anne, Toulon Armees, France
  1. Correspondence to Dr Christophe Joubert, Neurosurgery, Toulon 83000, France; christophe.joubert{at}


The management of a craniocerebral wound (CCW) remains challenging, particularly in a severely injured patient. Considering the complexity of the multilayer insult and damage control care in an unstable patient, every procedure performed should promptly benefit the patient. We report an illustrative case of a patient with a gunshot wound to the head that resulted in a CCW for which we applied vacuum-assisted closure (VAC) therapy according to damage control principles. We describe the technical approach and discuss the indications, results and technique by considering the literature available. VAC can be used for CCWs, particularly for large defects in selected patients according to clinical and CT evaluations following immediate resuscitation. In severely injured and unstable patients, VAC aims to delay definitive reconstructive and time-consuming treatment. Interestingly, it appears to be a safe treatment based on the previously described—but not exclusively trauma—cases with no secondary cerebrospinal fluid leakage encountered.

  • vacuum-assisted closure
  • penetrating craniocerebral trauma
  • severe traumatic brain injury
  • damage control
  • trauma management

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  • Contributors CJ is the first author who reported the case series and drafted the manuscript. AS and J-BM participated actively in the data collection and in literature research. CJ and NB carried out the data analysis and interpretation. JB and AD participated in the coordination and helped to draft the manuscript and reviewed the manuscript. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval Institutional Review Board of our structure (Sainte Anne Military Hospital).

  • Provenance and peer review Not commissioned; internally peer reviewed.

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