Vacuum assisted closure wound therapy

Vacuum assisted closure (VAC) is a technique of wound closure used to promote healing in large or chronic wounds, fight infection and enhance healing of burns. VAC seals the wound with a foam dressing and applies negative pressure to the wound bed with a tube threaded through the dressing. The vacuum may be applied continuously or intermittently, depending on the type of wound being treated and the clinical objectives. Intermittent removal of used instillation fluid supports the cleaning and drainage of the wound bed and the removal of infectious material. [cite journal | last = Bernstein | first = BH | coauthors = Tam H | year = 2005 | title = Combination of subatmospheric pressure dressing and gravity feed antibiotic instillation in the treatment of post-surgical diabetic foot wound: a case series | journal = Wounds | volume = 17 | issue = 2 | pages = 37–48 | url = http://www.woundsresearch.com/article/3757] [ cite journal | last = Fleischmann | first = W | coauthors = Russ M; Stampehl M | year = 1998 | title = Die Vakuumversieglung als Trägersystem für eine gezielte lokale Medikamentenapplikation bei Wundinfektionen | jounral = Unfallchirurgie | volume = 101 | pages = 649–654 | url = http://www.springerlink.com/content/ae5hx0vmt33wqtub/ ] [ cite journal | last = Wolvos | first = T | year = 2004 | title = Wound instillation – the next step in negative pressure wound therapy. Lessons learned from initial experiences | journal = Ostomy Wound Manage | volume = 50 | pages = 56–66 | url = http://www.o-wm.com/article/3261 ] cite journal |author=Moch D, Fleischmann W, Westhauser A |title= [Instillation vacuum sealing--report of initial experiences] |language=German |journal=Langenbecks Arch Chir Suppl Kongressbd |volume=115 |issue= |pages=1197–9 |year=1998 |pmid=9931834 |doi= |url=]

Mechanisms

A dressing, made of foam and containing a drainage tube, is fitted to the contours of a deep or irregularly-shaped wounds and sealed with a transparent film. The tube is connected to a vacuum source, turning an open wound into a controlled, closed wound while removing excess fluid from the wound bed to enhance circulation and remove waste from the lymphatic system. The technique is usually used with chronic wounds, or wounds that are expected to present difficulties while healing (such as those associated with diabetes or when the veins and arteries are unable to provide or remove blood adequately. [Michael S. Miller, DO, Rhonda Brown, LPN, and Cheryl McDaniel, LPN, Negative pressure wound therapy options promote patient care,BioMechanics 2005; 12(9):49-57] However, KCI claim that the VAC can be used for a variety of wounds, also those that are not as severe. [http://kci-medical.com/kci/corporate/kcitherapies/vactherapy/whatvactreats/]

KCI

In 1995 the Food and Drug Administration was presented with and first approved negative pressure equipment that was subsequently marketed as the VAC, by KCI (Kinetic Concepts, Inc). In medical trials, the treatment was as safe, and more effective, than moist treatment for diabetic ulcers.cite journal |author=Blume PA, Walters J, Payne W, Ayala J, Lantis J |title=Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial |journal=Diabetes Care |volume=31 |issue=4 |pages=631–6 |year=2008 |month=April |pmid=18162494 |doi=10.2337/dc07-2196 |url=http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=18162494]

Advantages

*Decreases wound volume [Joseph E., Hamori CA., Bergman S., Roaf E., Swann N., Anastasi G. Prospective Randomized Trial of Vacuum-Assisted Closure versus Standard Therapy of Chronic Non-healing Wounds. Wounds, 2000; 12(3) [http://www.medscape.com/viewarticle/407550] ]
*Removes excess fluids that can inhibit wound healingcite journal |author=Bucalo B, Eaglstein WH, Falanga V |title=Inhibition of cell proliferation by chronic wound fluid |journal=Wound Repair Regen |volume=1 |issue=3 |pages=181–6 |year=1993 |month=July |pmid=17163887 |doi=10.1046/j.1524-475X.1993.10308.x |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=1067-1927&date=1993&volume=1&issue=3&spage=181]
*Helps remove interstitial fluidcite journal |author=Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W |title=Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation |journal=Ann Plast Surg |volume=38 |issue=6 |pages=553–62 |year=1997 |month=June |pmid=9188970 |doi= |url=]
*Promotes granulation [Argenta, A., Webb K., Simpson J., Gordon S., Kortesis B., Wanner M., Kremers L., Morykwas M. Deformation of Superficial and Deep Abdominal Tissues with Application of a Controlled Vacuum. European Tissue Repair Society, Focus group meeting Topical Negative Pressure (TNP) Therapy, 4–6 December 2003, London.]
*Helps to decrease bacterial colonization at the wound site [Fleck CA, Frizzell LD. When negative is positive: a review of negative pressure wound therapy [http://www.extendedcarenews.com/article/2594] ]

Gallery

ee also

*Negative pressure wound therapy

References

External links

* [http://www1.wfubmc.edu/articles/VAC+Device.htm VAC therapy developed at Wake Forest University]