A feasibility study of a novel closed flowing vacuum-assisted technique (CFVAT) in managing fracture-related infection with implant retention

OBJECTIVE: The Closed Flowing Vacuum-Assisted Technique (CFVAT) is an innovative approach achieving continuous irrigation within a sealed wound environment, which enables active fluid circulation and establishes an efficient flowing-drainage mode under negative pressure. This study aims to conduct the first evaluation comparing the clinical outcomes of CFVAT versus the traditional Vacuum Sealing Drainage (VSD) technique in the management of early (≤ 6 weeks) fracture-related infection (FRI) involving internal fixation and classified as Cierny-Mader type II. METHODS: A retrospective study was conducted on 33 patients with early FRI (≤ 6 weeks, Cierny-Mader II) following internal fixation between 2021 and 2024. All patients underwent debridement with retention of internal fixation. The study group (n = 13) received CFVAT, while the control group (n = 20) received VSD. Patient demographics, fracture site, time from initial surgery to infection, inflammatory markers, number of required surgeries, total treatment duration, and costs were compared. RESULTS: The primary healing rate was 92.3% in the CFVAT group and 60% in the VSD group. The one-year long-term healing rates were 92.3% and 90%, respectively. The CFVAT group demonstrated advantages in the number of surgeries, treatment duration, and overall cost (P < 0.05). CONCLUSION: For a narrow clinical scenario-specifically early FRI (≤ 6 weeks) with retained internal fixation and Cierny-Mader type II anatomy-CFVAT may yield better outcomes than VSD in selected process and cost endpoints. These findings suggest that CFVAT has the potential to achieve wound closure after initial debridement while controlling infection. However, VSD remains a standard adjuvant therapy in FRI care, and the superiority of CFVAT requires validation through prospective randomized controlled trials. CLINICAL TRIAL NUMBER: Not applicable.