Vacuum-assisted closure in the treatment of gynecologic oncology wound failures

Abstract

Objective. Negative pressure wound vacuum therapy can expedite the healing of complex wound failures. Our aim was to evaluate the use of a vacuum-assisted closure (VAC) device to treat complex wound failures in gynecologic oncology patients. Methods. We retrospectively identified 27 patients with gynecologic malignancies in whom the device was used to treat complex wound failures from January 2001 to May 2002 at our institution. We analyzed operative data and information regarding the diagnosis and management of these complex wound failures and the length of time the device was used. Results. The procedures performed before wound VAC placement were total abdominal hysterectomy with bilateral salpingo-oopherectomy with or without tumor reductive surgery in 14 patients, vulvectomy with or without inguinal lymph node dissection in five patients, skin or myocutaneous grafting in three patients, parastomal herniorrhaphy in two patients, retroperitoneal lymph node dissection in two patients, and incision and drainage of a gluteal abscess after radiation therapy in one patient. Four of the 27 patients had the VAC device placed at the time of a reoperation, while the remaining 23 patients had the VAC device placed postoperatively for wound failures. Wound breakdown occurred at a median of 9 days (range: 0–88 days) postoperatively. Overall, there was a 96% reduction (range: 0–100%) in the median size of wound defects from 330 to 14.0 cm 3 with use of the VAC device. The median number of days of VAC therapy was 32 days (range: 3–88 days). Twenty patients used this device as outpatients, and the charge per day was approximately US$150.00. One patient experienced bleeding, and 26 patients experienced no complications. The only complaint was pain during dressing changes (67% of patients). The mean follow-up was 52 days (range: 0–270 days). At the time of last contact, 26 (96%) of 27 patients had complete wound healing. Conclusions. VAC therapy is a novel treatment using controlled negative pressure to evacuate wound fluid, stimulate granulation tissue, and to decrease bacterial colonization of the wound. Our experience indicates that this is a safe method to treat complex wound failures in gynecologic oncology patients.