V.A.C.® Therapy in Home Care

Abstract

Around the world, the numbers of patients with acute and chronic wounds is increasing as the population ages. In addition, a global epidemic of diabetes mellitus is emerging as we move to a faster paced life style with relatively sedentary occupations, refined foods, and an increase in obesity. Healthcare professionals need to look for new solutions to treat patients with wounds that will improve patient’s quality of life at an affordable cost for health care systems. The care of chronic wounds is shifting from institutions to home care in the community, with consequent new challenges related to the coordinated delivery of care Clinical decisions regarding the care of the individual patient should be based on current best evidence to optimize individual patient outcomes. Although many aspects of wound care are subjected to the scientific methods for the pursuit of clinical knowledge, consideration of clinical expertise and patient preference is equally important. We advocate the term ‘evidence informed practice’ to recognize the merit of tacit knowledge and personal interpretation, reflection, deliberation, and application of evidence. It is by recognizing that this paradigm shift is required the disparity between knowledge and its implementation can be minimized. To optimize wound healing, clinicians must address the underlying cause of the patients wound and patient centered concerns prior to selecting local wound treatments. Several experimental studies have documented that negative pressure wound therapy (NPWT) has improved tissue proliferation by altering molecular and cellular responses. In this supplement, key clinical studies and analyses are presented to substantiate the clinical efficacy and safety of NPWT. Wu and Armstrong appraised the literature focusing on diabetic foot ulcers (DFUs) that were treated by surgical interventions. They reported a significant improvement in healing and reduction in subsequent surgical interventions using NPWT. The authors highlighted the potential cost savings and improvement on quality of life. Fife et al. reviewed data from 1331 patients with DFUs treated in the community. The number of adverse events reported while patients were treated with NPWT was similar to patients in the control group receiving conventional dressings. More importantly, wounds that were treated with NPWT demonstrated faster healing trajectories. In the article by Trueman, economic studies are reviewed and demonstrate the home care cost effectiveness of NPWT using V.A.C. technology for pressure ulcers. This supplement reviews abundant evidence to illustrate the benefits of NPWT with V.A.C. technology on various types of chronic wounds across the continuum of patient care settings. Early implementation and regular evaluation of NPWT is crucial to promote the best possible patient outcomes and cost savings. Needless to say, many barriers and challenges to implement advanced wound therapy exist within the health care system. We are presenting an educational model built on the principles of the educational evidence based literature to translate the NPWT via V.A.C. technology for the successful treatment of carefully selected home care patients. This model highlights the importance of professional development and leadership to ensure the appropriate utilization of NPWT. The third meeting of the World Union of Wound Healing Societies will give us the opportunity to bring together a panel from North America and Europe to help translate the use of new technology into the home care arena. The authors of this supplement will have a unique opportunity to share experiences outlined in this volume with a global audience of interprofessional wound healers. Optimal patient outcomes require the implementation of new scientific evidence based research into clinical practice incorporating the knowledge of successful strategies from the educational evidenced based literature. Negative pressure wound therapy using V.A.C. technology is an intervention that can facilitate faster healing that is important for patients, healthcare professionals and providers of health care systems. R. Gary Sibbald is a Consultant/Advisor, a member of the Speaker’s bureau and has and is receiving grant/research funding from Coloplast, Smith and Nephew, 3M, KCI, Molnlycke, Covidien and Johnson & Johnson. Kevin Woo was and is a Consultant/Advisor for Coloplast, Molnlycke, KCI, the Registered Nurses Association of Ontario and Merck. He is a member of the Speaker’s Bureau for Johnson & Johnson, Coloplast and Molnlycke. Has and is receiving grant/research funding from the Canadian Association of Wound Care.