Evidence-based Literature Review
EXAMPLE ONLY!
Title: Treatment of Traumatic Soft Tissue injury – Motor Vehicle versus Pedestrian Accident
Authors: Shannon Smith, BSN, RN; Susan Brown, CCRN, RN; Anjay Khandelwal, MD
Author Affiliations: Arkansas Children's Hospital Burn Center
Clinical Significance: Injuries sustained by children involved in motor vehicle accidents often require prolonged and
complex care. Large wounds resulting from severe injuries have been treated mainly with extensive reconstruction operations
associated with long hospital stays and risks of complications. The overall goal in treating traumatic large soft tissue wounds
in children is closing the wounds with the least amount of use of donor skin from the patient and with the least amount of scar
tissue. Currently the Burn Center at Arkansas Children’s Hospital is using a dermal regeneration template and negative
pressure therapy to treat and close these wounds in a very safe and timely manner.
Statement of the Problem (or Purpose): The purpose of this work was to explore evidence from literature, practice
guidelines, and clinical setting experience to evaluate wound care.
PICO Format Question: In pediatric patients recovering from pedestrian versus motor vehicle accident, does dermal
regeneration template placement with negative pressure therapy, compared with wound debridement and grafting lead, to
faster more effective healing?
Literature Search Strategy: The literature search process used Pubmed, Google Scholar and EBSCO. Search terms used to
locate the appropriate literature were degloving injury treatment, dermal regeneration template, vacuum assisted closure,
debridement, reconstruction and autografting.
Literature Search Results & Evidence: The literature search produced an initial total of 133 studies.
We eliminated studies without pediatric injuries, leaving 10 studies. For many years, wound debridement with placement of
allografts to cover the open wounds has been the treatment of choice, followed by split thickness auto grafting to the entire
wound bed once it is ready. This treatment, while safe and effective, requires large open wounds to be covered by the patient’s
own donor skin, causing pediatric patients to be more prone to open wound infections, decreased mobility and longer, more
painful healing times with greater scarring. The use of dermal regeneration template after wound debridement allows for the
neodermis to be regenerated with little to no scar formation as collagen is formed. The treatment of pediatric traumatic soft
tissue extremity wounds is the widest reported indication for negative pressure vacuum therapy due to edema reduction,
improved granulation tissue, increased vascularity and wound contraction. Thus, the patient requires less body surface area to
be grafted to cover open injuries with less surface area used for donor skin sites.
Evidence from Clinical Case: We treated a seven year old male pedestrian who was injured by a motor vehicle (18 wheeler)
resulting in multiple large soft tissue injuries, pelvic fractures, open tibia fracture, and complete proximal urethral dissection.
Our pediatric patient required six surgical procedures that included debridement of the soft tissue injuries, placement of
dermal regeneration template with negative pressure vacuum therapy and ultimately auto grafting. The treatment was
successful and the patient was discharged in less than 2 months, a relatively short hospital stay for the nature of his injuries,
with healed wounds and the ability to ambulate in excess of 80 feet several times daily.
Comparison and Synthesis of Evidence: The articles and guidelines in our literature search together with our clinical
experience demonstrate that the use of wound debridement, application of dermal regeneration template and ultimately auto
grafting the open areas, along with negative pressure wound vacuum therapy is safe and provides the patient with a smaller
surface area to heal and better cosmetic effects with less scarring.
Conclusions and Implications for Nursing Practice: The combined evidence from the literature and clinical experience
with our young patient demonstrated that dermal regeneration template and negative pressure vacuum therapy can generate
positive outcomes for complex soft tissue injuries in pediatric victims of trauma. Care for these patients requires a holistic
approach, awareness of treatment options, and interprofessional teamwork.