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Abstract: The leeching effects of the Limited Access Dressing (LAD) effectively controls infection, reduces edema, promotes earlier physiotherapy, and helps to control secondary damage to trauma cases, which results in faster wound bed preparation, reconstruction, and quicker rehabilitation. The following is a case series of 20 consecutive patients treated with LAD without specific controls. In eight cases bone was exposed, in three cases tendon was exposed, in two cases both bone and tendon were exposed, and in one case an injured brachial artery was exposed. Methods. After saline wash, the LAD with intermittent negative pressure was applied (30 minutes negative pressure, 3.5-hour rest period). Wound debridement and physiotherapy were started on day 1 as necessary. Second stage elective procedure was done after healthy granulation tissue had covered exposed tendon, bone, and vessels. A split-thickness skin graft (SSG) was then applied to cover the wound. Results. Excellent graft take (> 99%) was seen in 18 of the 20 cases where skin grafting was done under LAD. The time taken to prepare the wound for resurfacing (after skin grafting) was less than 6 weeks in the majority (16/18) of cases. Post discharge physiotherapy to achieve maximum possible mobilization in upper extremity (10/20) cases was less than 6 weeks in most cases (6/10). The average cost of treatment was Rs. 16071.00 (US $365). Conclusion. LAD is an effective tool for damage control in trauma cases.

  Early surgical treatment of poly-trauma has not always been advocated. It was believed that the poly-traumatized patient did not have the physiological reserve to withstand prolonged operations. Extended operative procedures during the early phase of multiple trauma recovery were associated with adverse outcomes. In response, the concept of damage control in trauma patients was developed in the 1990s. The damage control methodology is characterized by primary, rapid, and temporary stabilization of patient’s general and local condition. Secondary definitive management follows once the acute phase of systemic recovery has passed.¹

  Although this approach is especially adaptable to the patient with acute and complex trauma, it is also applicable to a wide variety of other non-traumatic surgical encounters. A surgeon facing a complex surgical challenge has three philosophical concepts at his or her disposal: 1) avoidance, 2) aggressive attempts at complete reversal or control of the condition, and 3) temporizing maneuvers.² The concept of initial temporary control using Limited Access Dressing (LAD) with a staged definitive approach at a later date as an elective procedure for a patient with extensive wounds (including burns) has many benefits. LAD combines the principles of moist wound healing and topical negative pressure dressing along with a provision of an additional port (12-14 Fr tube) for manipulating the wound environment without the need to change the dressing.³