Vacuum-assisted Closure Application Research Articles

Successful use of platelet-rich plasma as a regeneration technique for a non-healing diabetic leg ulcer with chronic osteomyelitis: A case report

Chronic diabetic leg ulcers can be challenging to manage, particularly when osteomyelitis coexists resulting in serious or even life-threatening conditions if not managed appropriately. Such cases require very long periods of treatment with several debridements, antibiotic bead implants, skin grafts or even amputations in many unfortunate cases. Despite that, conventional management appears to be inadequate with poor outcomes and a higher relapse rate. We report a case of a 26-year-old type 1 diabetic female patient presented with a history of non-healing diabetic leg ulcer complicated by chronic osteomyelitis of the left leg. Several wound debridements were performed with the application of vacuum-assisted closure, and culture-guided antibiotics were given. However, only minimal improvements were observed. Eventually, the leg was labeled as an unsalvagable limb due to poor blood supply based on an ankle-brachial index. Platelet-rich plasma (PRP) was tried showing promising results and significant improvement as confirmed by a gallium scan, which showed evidence of osteomyelitis remission. Two months later, the patient improved significantly with the ulcer healed and the osteomyelitis resolved. Autologous PRP promotes wound healing by providing necessary growth factors, reducing inflammation, and showing bactericidal activity. All efforts must be taken to preserve any limb before labeling it non-salvageable. This case report aimed to draw attention to the method that can be implemented to manage non-healing diabetic leg ulcers complicated by chronic osteomyelitis.

IMPROVING SURGICAL STRATEGIES FOR TREATING EXTENSIVE SOFT TISSUE WOUNDS RESULTING FROM MINE AND EXPLOSIVE TRAUMA

Introduction.Since February 24, 2022, a primary focus of surgical care in Ukraine has been to provide assistance to citizens affected by Russian aggression. A significant proportion of wounds and injuries sustained in this context involves mine-explosive wounds, manifesting as soft tissue damage in the form of lacerations, shrapnel injuries, and wounds of varying degrees of contamination and size.
 The widespread adoption of Vacuum-Assisted Closure (VAC) therapy for wounds characterized by extensive muscle and skin defects involves the localized application of negative pressure to damaged tissues. Typically, this precedes planned autodermoplasty, which, despite being a scheduled intervention, follows urgent surgical corrections. These interventions offer a distinct opportunity for individuals with substantial soft tissue injuries— and, as evidenced by experience, not limited to them— to restore their pre-injury quality of life.
 The aim of this study is to enhance the quality of life for individuals affected by mine-explosive injuries and extensive soft tissue wounds.
 Materials and methods. The outcomes of surgical treatment of 57 civilian victims afflicted by landmine-explosive wounds and extensive soft tissue injuries were examined. These individuals underwent treatment at the Surgical Department of the Regional Clinical Hospital" during the period 2022 – 2023. Among the cohort, 34 were women, constituting 59%, while 23 were men, representing 41%, the ages of the patients ranged from 34 to 74 years.
 Results and discussion. All 57 patients initially underwent surgical treatment of wounds, involving the removal of foreign bodies if present, necrectomy, and subsequent application of the second-stage Vacuum-Assisted Closure (VAC) therapy. The VAC therapy was used to cleanse the wounds and reduce their surface area. Continuous VAC therapy was administered at a negative pressure ranging from 50 mmHg (on the anterior abdominal wall and the back surface of the chest) to 110 mmHg (on tissues of the lower extremities). The replacement of the VAC dressing occurred every 3-5 days, contingent upon the quantity and quality of the exudate, with typically 2-3 changes required. The third stage involved the application of free autodermoplasty utilizing a perforated skin flap. Mechanical wound treatment was performed iteratively until the level of "bloody dew" was reached.
 We suggest that all these stages are essential for achieving favorable treatment outcomes, irrespective of any severe accompanying pathology that may arise. Indeed, comorbidity stands out as a defining factor that distinguishes the civilian population qualitatively from the military category.
 Conclusions. The application of Vacuum-Assisted Closure (VAC) therapy followed by autodermoplasty in the management of extensive soft tissue injuries caused by mine-explosive incidents significantly enhances the efficacy of surgical treatment and reduces the period of patient incapacitation, presenting clear economic benefits. Autodermoplasty, in particular, holds a commendable position within the realm of reconstructive surgery for mine and explosive wounds. Within this context, autodermoplasty emerges as a surgical intervention that not only yields positive aesthetic outcomes but also facilitates an accelerated adaptation of the affected body part. This, in turn, contributes to an improved quality of life for victims of mine-explosive trauma grappling with substantial soft tissue damage.

Evaluation of Negative Pressure Wound Therapy in the Management of Fournier's Gangrene.

Introduction Necrotizing soft tissue infections (NSTIs), including Fournier's gangrene (FG), are severe polymicrobial bacterial infections characterized by rapidly spreading inflammation and tissue necrosis. This study aims to compare the clinical outcomes of vacuum-assisted closure (VAC) dressing and conventional dressing in patients with FG. Materials and methods A prospective study was conducted from December 2020 to May 2022, including patients with clinical features suggestive of FG. Patients were divided into two groups: conventional dressing and VAC dressing. Relevant clinical data, including age, duration of hospital stay, wound status, Fournier's gangrene severity index (FGSI) scores, sepsis markers (C-reactive protein (CRP), neutrophil-to-lymphocyte ratio, and procalcitonin), and pain assessment, were recorded and compared between the two groups. Results A total of 84 patients were included in the study, with 42 patients in each group. The mean age was 57.48 ± 15.74 years in the conventional dressing group and 50.83 ± 13.95 years in the VAC dressing group. VAC dressing was associated with a significantly shorter duration of hospital stay (8.14 ± 3.13 days) compared to conventional dressing (11.36 ± 4.75 days). The average time taken for wound closure was significantly reduced in the VAC dressing group (63 ± 14.81 days) compared to the conventional dressing group (112.56 ± 13.82 days). FGSI scores showed significant improvement after debridement in both groups, with lower scores in the VAC dressing group at discharge. Sepsis markers such as CRP and serum procalcitonin exhibited a significant decrease after VAC application. Discussion The study demonstrates that VAC therapy is associated with better clinical outcomes in FG, including reduced duration of hospital stay, faster wound closure, improved FGSI scores, decreased sepsis markers, and reduced pain. These findings align with previous studies highlighting the advantages of VAC therapy over conventional dressing methods. Conclusion VAC therapy provides significant benefits in the management of FG, leading to improved clinical outcomes and patient quality of life. It offers advantages such as shorter hospital stays, faster wound closure, and reduced sepsis markers. The application of VAC dressing should be considered a valuable treatment modality for FG.

Delayed Sternal Closure Using a Vacuum-Assisted Closure System in Adult Cardiac Surgery.

Delayed sternal closure (DSC) is a useful option for patients with intractable bleeding and hemodynamic instability due to prolonged cardiopulmonary bypass and a preoperative bleeding tendency. Vacuum-assisted closure (VAC) has been widely used for sternal wound problems, but only rarely for DSC, and its efficacy for mediastinal drainage immediately after cardiac surgery has not been well established. Therefore, we evaluated the usefulness of DSC using VAC in adult cardiac surgery. We analyzed 33 patients who underwent DSC using VAC from January 2017 to July 2022. After packing sterile gauze around the heart surface and great vessels, VAC was applied directly without sternal self-retaining retractors and mediastinal drain tubes. Twenty-one patients (63.6%) underwent emergency surgery for conditions including type A acute aortic dissection (n=13), and 8 patients (24.2%) received postoperative extracorporeal membrane oxygenation support. Intractable bleeding (n=25) was the most common reason for an open sternum. The median duration of open sternum was 2 days (interquartile range [25th-75th pertentiles], 2-3.25 days) and 9 patients underwent VAC application more than once. The overall in-hospital mortality rate was 27.3%. Superficial wound problems occurred in 10 patients (30.3%), and there were no deep sternal wound infections. For patients with an open sternum, VAC alone, which is effective for mediastinal drainage and cardiac decompression, had an acceptable superficial wound infection rate and no deep sternal wound infections. In adult cardiac surgery, DSC using VAC may be useful in patients with intractable bleeding or unstable hemodynamics with myocardial edema.

To evaluate the role of VAC therapy in open fractures after primary fixation in term of faster and more effective wound healing

Vacuum-assisted closure (VAC) is a noninvasive, active wound management system that exposes a wound bed to local sub atmospheric pressure, removes fluid from the extravascular space, improves circulation, and enhances the proliferation of granulation tissue. The purpose of this study is to know the rate of wound infection, number of days required for making the wound fit for skin cover procedures, number of days required for formation of uniform granulation tissue bed in the wound healing treated by Vacuum Assisted Closure after primary fixation of fracture.Patients between 18 to 60 years were included in this prospective randomized controlled trial. Primary internal Fixation of fracture was done as soon as possible followed by VAC application. Functional outcome of cases recorded during each follow up according to Johner and Wruh’s (1983).According to this study, 30 patients with open fractures of both bone leg after primary internal fixation with VAC application. During follow up effective decrease (mean ± SD) in wound size after VAC therapy was 9.97±9.59 cm2 with P-value 0.0481. This technique has resulted in the effective decrease in wound size, infection and give a better functional outcome.The greatest advantage of VAC was found to facilitate rapid formation of granulation tissue on wounds with exposed tendons, bones, raw area wounds and exposed implants hence decrease healing time and minimize soft tissue defect coverage procedures.

VACUUM-ASSISTED CLOSURE AND MUSCLE FLAP AS AN ALTERNATIVE MODALITY FOR INFECTED WOUND AFTER ORIF OF TIBIAL FRACTURE: CASE REPORT

Background: The blood supply of a bone can be decreased due to the use of an implant, leading to wound-bed bacterial colonization and the development of the SSI. The principle of vacuum-assisted closure (VAC) is to use a negative pressure environment in the wound to promote increased wound healing. The case shows that VAC application and muscle flap therapy provide the definitive healing of infected wounds after ORIF. Case Report: A 45 years-old male presented with a close comminuted proximal third right tibia fracture and tense skin. The fracture was openly reduced and internally fixated with plate fixation and a skin flap on the fracture area. Still, the wound could not be closed due to difficulty covering the wound, so a counter incision was made. After four days, the patient developed necrosis in the post-operation wound and subsequently underwent debridement and muscle flap with VAC application. Discussion: SSI can be treated by applicating of appropriate antibiotic and surgical procedures. In this case, the infection was treated using third-generation cephalosporin antibiotic, debridement, dissection, and re-elevation of gastrocnemius muscle flap covering the exposed plate area in inferior, split skin graft above the muscle flap and VAC above skin graft with 75 mmHg pressure. Conclusion: Debridement with muscle flap and application of VAC in the deep infected wound of open reduction and internal fixation was found to be successful methods in minimizing complications and obtaining an optimal outcome. This finding was associated with accompanying morbidities or a good wound healing process.

Modified application of vacuum-assisted closure in thoracic surgery patients

Surgical site infection (SSI), ranging from superficial, deep and to organ space, is one of the major predictors for morbidity and mortality in patients undergoing thoracic surgery. Care to accelerate SSI healing is taken to shorten hospital stay and reduce costs. The deep application of vacuum-assisted closure (VAC) in thoracic patients is not well established in the literature. In this study, the deep application and safety of VAC therapy in patients with various thoracic pathologies was evaluated. A retrospective chart review of all patients who were admitted to the thoracic surgery service between July 2014 and July 2018 and who developed deep SSI was carried out. A total of 12 patients were included, and their demographic data analysed. There were various thoracic pathologies complicated with postoperative deep SSI treated with VAC. The duration of VAC application ranged from 4-40 days with an average hospital stay of 37.6 days. All patients showed clinical, radiological and microbiological improvement rather than developing complications except for one case of mortality due to septicaemia. In this study, partial intrapleural VAC therapy was safe for use in patients who underwent thoracic surgery, regardless of the underling pathology, with caution (i.e., with continued monitoring of the patient's tolerance to the treatment). The overall hospital stay may be reduced with the use of VAC. It also decreased perioperative morbidity, secondary to wound infection.

Comparison of vacuum assisted closure therapy with conventional dressing in the management of necrotizing fasciitis wound

Background: The purpose of our study was to compare the effect of vacuum assisted closure (VAC) therapy and conventional dressings in patients with open wounds due to necrotizing fasciitis (NF) on the basis of healing rate, infection control, frequency of dressing and pain score.Methods: The study evaluated 50 patients admitted with NF requiring surgery over a period of 18 months. The patients were randomized to two groups. In group A patients, the wounds were managed with conventional dressings and in group B patients, negative pressure wound therapy (NPWT) was applied. Serial assessment of both groups was done for four weeks. The parameters including size of wound, wound bed, granulation tissue formation, color, amount and odor of exudate, edema, frequency of dressing, re-debridement and pain were monitored and analysed.Results: In our study, patients with NF wounds who underwent VAC therapy had earlier granulation tissue formation, resolution of infection and readiness for skin grafting. The frequency of dressing, requirement of re-debridement, resolution of edema, odor, skin maceration, inflammation around wound and pain significantly reduced in group B (VAC) when compared to conventional dressing group.Conclusions: When compared to the conventional dressing on NF wound, application of VAC helped in early appearance of granulation tissue, significant reduction of inflammation, wound odor, exudate, need for re-debridement, frequency of dressing and pain. Thus, VAC dressing can be considered as a better option in the management of NF wounds.

The use of incisional vacuum-assisted closure system following one-stage incision suture combined with continuous irrigation to treat early deep surgical site infection after posterior lumbar fusion with instrumentation

BackgroundPrevious reports concerning deep surgical site infection (SSI) after posterior spinal instrumentation treated with vacuum-assisted closure (VAC) system indicated that most patients must suffer from a delayed incision suture. To date, there are no published reports about the application of incisional VAC following a one-stage incision suture in the treatment of spinal infections. The purpose of this study was to evaluate the feasibility and efficacy of using an incisional VAC system following a one-stage incision suture combined with continuous irrigation to treat early deep SSI after posterior lumbar fusion with instrumentation.MethodsTwenty-one patients who were identified as early deep SSI after posterior lumbar fusion with instrumentation were treated by incisional VAC following a one-stage incision suture combined with continuous irrigation at our spine surgery center between January 2014 and March 2020. Detailed data from medical records were collected and analyzed, including age, gender, primary diagnosis, original operation, number of VAC dressing changes, duration of continuous irrigation, hospital stay, risk factors for infection, bacteria type, and laboratory data. Clinical efficacy was assessed using the pre- and postoperative visual analog scale (VAS) for back pain and Kirkaldy-Willis functional criteria by regular follow-up.ResultsAll the patients were cured and retained implants with an average of 1.9 times of VAC dressing replacement, and an average of 10.2 days of continuous irrigation. There were significant differences between pre-operation and post-operation in ESR, CRP, and VAS score of back pain, respectively (P < 0.05). The satisfactory rate was 90.5% according to Kirkaldy-Willis functional criteria. One patient developed a back skin rash with itching around the wound because of long-time contact with the VAC dressing. There was no recurrent infection or other complications during follow-up.ConclusionsOur preliminary results support that the treatment protocol is feasible and effective to treat early deep SSI following posterior lumbar fusion with instrumentation.

Role of VAC Dressing in the Large Open Fracture: A Single Center Prospective Study from Indore

Background: As the body's protective skin barrier is breached in open fractures, and the potential of contamination is high, these can lead to significant morbidity. Vacuum-assisted closure (VAC) is the application of the negative pressure in open wounds, and it significantly improves wound healing both at the macro and micro levels. Material and Method: A total of 30 patients (23 males and 7 females with a mean age of 27 years) with large open fractures of long bones who received VAC therapy during the early period of treatment were studied. VAC dressing over wound was done following percutaneous pinning or external fixation. In addition, rates of infection, fracture union, duration of application of VAC, and the association of duration of VAC with the development of complications were evaluated. Results: The mean time between the trauma and the first debridement was 8.20 hours (range, 2–23). The mean duration of VAC application was ten days (range, 3–16). Delayed wound closure was performed in nine patients. In the remaining 21 patients, the mean decrease in the wound dimensions between pre and post-VAC application was found to be 43.06% (range, 20–60%). Conclusion: VAC application increases the patient's comfort by reducing the need for dressing changes, improves blood circulation, accelerates the formation of granulation tissue, reduces the rate of infection from the hospital environment, decreases edema, alleviates the need for secondary interventions, and also decreases wound dimensions. Keywords: wound, open fractures, vacuum-assisted closure, wound healing.

VAC (Vacuum assisted closure) in the management of chronic non-healing wounds: Institutional study

Background: The management of chronic non- healing wounds has always been a cause of concern for the patients and treating team as well. There had been a marked increase in patients presenting with chronic non -healing wounds of varied etiology. The conventional methods of treatment have been in use traditionally include different medicated dressing application since the long-time yet desired results are not achievable always and some other applications like collagen are mostly not affordable to the poor local population. Vacuum-assisted closure using negative pressure being considered as a suitable alternative management for treating chronic non-healing wounds and the results are comparatively better in relatively lesser time than the conventional techniques. Objective: To assess the impact of (VAC) in the management of non-healing Ulcers To compare the advantage of VAC over conventional dressings in ulcer management Methods: Prospective controlled study of 60 patients aged between 40 and 60 were randomly divided into two groups (Wagner grade 2-5) VAC dressing was kept for over 2-5 weeks. Ulcers were treated until the wound closed spontaneously, surgically or until completion of the 50 days, whichever was earlier. Results: By the seventh week, discharge disappeared in 94 % in VAC and only 56 % in conventional dressing group. Granulation tissue appeared in 100 % of patients in the VAC group and only 63 % in the conventional dressing group. The patients treated with VAC dressing in our study showed comparable wound reduction capabilities with an average wound size reduction of 58 % in comparison to conventional dressing group which had an average wound size reduction of 26 %. Majority of wounds in the VAC group got closed in 7 weeks. Patient satisfaction was very good in the VAC group compared to those patients managed with conventional dressing group. Conclusion: The application of VAC is feasible, reliable and affordable with a better outcome in the management of chronic non-healing ulcers.

Role of vacuum assisted closure (VAC) in treatment of difficult to heal wounds in lower extremity- our experience in 100 cases

Aims and objectives 1. To study effectiveness of lower limb problems like: lower limb injuries, difficult to heal wounds like amputation stumps, necrotizing fasciitis, diabetic foot, burns wounds and deep electrical burns wounds, cellulitis and extensively oozing wounds. 2. Improvement in take of graft or flap. 3. Reduction of infection and surface bacterial count in wounds reducing morbidity and mortality and making treatment cost effective, also. 4. Salvaging lower limbs. Methods: Standard method of VAC application is used in our study with step wise manner. Wound debridement, hemostasis done, VAC applied by standard method. Negative pressure around 125 to 150 kept in our study. Out of 100 cases, 50 cases are lower limb injuries due to trauma, accident, amputation stumps, 40% cases are due to necrotising fasciitis and cellulitis, septicaemia. 10% cases are due to bedsore and its infection management. Lower limb wounds with exposed tendons or bones, orthopaedic implants exposed,-are well managed with VAC. Standard method of VAC application is followed in each case. Result: Out of 100 cases of lower limb problems with difficult to heal wounds, amputation stumps treated, we found infection is effectively reduced, wound discharge is reduced, wounds granulated well and early, and wound bed prepared early for skin graft take or flap take. Conclusion: Vacuum assisted closure (VAC) is very good modality of treatment, which assists plastic surgeons in healing wounds specially in difficult to treat lower limb wounds.

Use of incisional vacuum-assisted closure in the prevention of postoperative infection in high-risk patients who underwent spine surgery: a proof-of-concept study.

This proof-of-concept study was conducted to determine whether negative-pressure wound therapy, through the use of incisional vacuum-assisted closure (VAC), is associated with a reduction in surgical site infections (SSIs) when compared to standard wound dressings in patients undergoing open posterior spinal fusion who have a high risk of infection. A total of 64 patients were examined; 21 patients received incisional VAC application (VAC group) versus 43 diagnosis-matched patients who received standard wound dressings (control group). Patients in the VAC group were prospectively enrolled in a consecutive series between March 2013 and March 2014 if they met the following diagnostic criteria for high risk of infection: posterior open surgery across the cervicothoracic junction; thoracic kyphosis due to metastatic disease; high-energy trauma; or multilevel revision reconstructive surgery. Patients in the VAC group also met one or more comorbidity criteria, including body mass index ≥ 35 or < 18.5, diabetes, previous radiation at surgical site, chemotherapy, steroid use, bedridden state, large traumatic soft-tissue disruption, or immunocompromised state. Consecutive patients in the control group were retrospectively selected from the previous year by the same high-risk infection diagnostic criteria as the VAC group. All surgeries were conducted by the same surgeon at a single site. The primary outcome was SSI. All patients had 1 year of follow-up after their surgery. Baseline demographics, intraoperative parameters, and postoperative wound infection rates were compared between groups. Patient demographics including underlying comorbidities were similar, with the exception that VAC-treated patients were malnourished (p = 0.020). VAC-treated patients underwent longer surgeries (p < 0.001) and required more postoperative ICU admissions (p = 0.039). The median length of hospital stay was not different between groups. In total, 9 control patients (21%) developed an SSI, versus 2 VAC-treated patients (10%). Patients in this cohort were selected to have an increased risk of infection; accordingly, the rate of SSI was high. However, negative-pressure wound therapy through VAC application to the postoperative incision resulted in a 50% reduction in SSI. No adverse effects were noted secondary to VAC application. The preliminary data confirm the authors' proof of concept and strongly support the need for a prospective randomized trial.

VAC (Vacuum assisted closure) Therapy with k wire fixation as management protocol in complex compound foot fractures with soft tissue defects

Many patients who sustain high energy compound fractures of lower extremities are riddled with severe contamination of wound with soft tissue loss. This results in deep infections, non unions and in few cases, amputations. We present a case series of 10 cases with compound fractures of foot with severe degloving injury and wound contamination. Treatment entailed through debridement and was with 5 litres of saline along with betadine. Fractures were fixed with K wires and wound was covered with primary VAC application. Male to female ratio was 8:2. Most of the cases were road traffic accidents. The average number of VACs applied were 2.3. 80% cases underwent split skin graft.We conclude that VAC with K wire fixation is an effective and safe treatment in compound fractures of foot with degloving injuries.

Acute compartment syndrome of the foot: An unusual case caused by Graston technique

The purpose of this case report is to describe an unusual cause of compartment syndrome of the foot that developed subsequent to the use of Graston technique in a patient who had recently underwent revision total hip arthroplasty (THA). A 60-year-old female presented for orthopedic follow-up care in the office, 10 days postoperatively following an explant of her right hip Prostalac® spacer (DePuy) for previous infection and conversion to right THA (DePuy CORAIL® Hip System) complaining of severe right foot pain, swelling with pressure in foot, paresthesia, and inability to bear weight. The patient had undergone Graston technique for bilateral foot swelling by her home physical therapist. The patient was clinically diagnosed with acute compartment syndrome (ACS) of her right foot and underwent intervention. The treatment consisted of acute fasciotomy of her right foot with vacuum-assisted closure application. Delayed closure was initiated once soft-tissue decompression occurred. Due to acute fasciotomy, ambulation was inhibited and physical therapy delayed. The postoperative course was uneventful following the release of tense compartments, weight bearing was resumed once incisions healed, and the patient was pain free while deep-venous thrombus prophylaxis was continued. No further issues occurred postoperatively, and the patient showed overall clinical improvement. Residual soft swelling can be expected following hip surgery, especially at the caudal end of limbs. Immobilization enhances this engorgement. However, due to the aggressive Graston technique performed by the therapist, the patient developed ACS of the foot. Graston technique has been documented to increase blood flow to treated areas. Early and aggressive intervention should be initiated if ACS is clinically or objectively found, as late detection may have disastrous results.

Role of Vacuum-Assisted Closure in the Management of Crohn Anal Fistulas.

Patients with Crohn disease-related anal fistulas are treated with debridement of fistulous tracts and the placement of noncutting setons (NCSs). However, to reduce the high recurrence rate, there is still a need to develop more effective treatment methods. To compare NCS with vacuum-assisted closure (VAC) treatment. Medical records of 47 patients with Crohn anal fistulas were retrospectively evaluated. They were divided into two groups (I, VAC; II, NCS), consisting of 24 and 23 patients, respectively. The fistulas in the former group were applied with VAC, whereas NCSs were placed in the latter group. Fistula healing was evaluated with the Fistula Drainage Assessment classification, Perianal Disease Activity Index, and the van Assche MRI-Based Score. There was a significant difference (P = .006) between the groups; closure of all fistulas at 6 months after treatment was achieved in 18 patients (75%) from group 1, compared with 8 patients (35%) from group 2. Partial response occurred in five patients (21%) from group 1 and in five patients (22%) from group 2. Closure of fistulous tracts was visualized via MRI in nine patients (37.50%) from group 1, more than twice as many patients as from group 2. Because preliminary results of the study showed a high rate of closure after application of VAC to Crohn anal fistulas, this method might be considered a novel sphincter-saving procedure.

Vacuum-Assisted Closure (VAC) Using Multiple Foam Pieces for Hidden Space Drainage through Less Exposure in Musculoskeletal Infections.

Purulent musculoskeletal infections often require surgical debridement and drainage. However, when the infection is extensive or involving multiple layers of tissues, maintaining drainage of the involved spaces can be difficult, even with the application of vacuum-assisted closure (VAC) therapy. Wide exposure and aggressive debridement is often required for such cases, which in turn may complicate wound coverage. A retrospective review was performed for 16 patients with musculoskeletal infections treated surgically. The diagnosis for the patients consisted of necrotizing fasciitis, large soft tissue abscess, peri-hardware abscess, infected compartment syndrome, emphysematous osteomyelitis, and gas gangrene of diabetic foot. We minimized the incision and resection for debridement and drainage, and instead we placed multiple foam pieces between the tissues involved with VAC, to maintain drainage of the hidden spaces with negative pressure. Infection was successfully controlled in all cases. The mean duration of VAC treatment was 16.1 days (range, 5-36) and the mean number of VAC changes was 5.1 (range, 1-13). Primary wound closure was achieved in 11 cases, while skin grafts were used to cover the remaining five cases, which consisted of necrotizing fasciitis, infected compartment syndrome, and diabetic foot gas gangrene. No complications specifically associated with VAC therapy were observed. VAC using multiple foam pieces for hidden space drainage appears to be effective for infection control. It is helpful for minimizing exposure and resection for drainage and debridement, although subsequent reduction of the necessity or the level of wound coverage should further be investigated.

Vacuum assisted closure: Review on current application for post-operative wound management in orthopaedics

Background: Post operative wound dehiscence is a significant health problem. In imposes social and financial burdens. If the injury involves the exposure of bone, early coverage of the defect must be a goal of treatment to prevent secondary problems such as an osteogenic infection. Vacuum-assisted closure (VAC) therapy has been developed as an alternative to the standard forms of wound management, which incorporates the use of negative pressure to optimise conditions for wound healing and requires fewer painful dressing changes. It is a wound management system that exposes a wound bed to local negative pressure to promote healing. This article reviews the use of VAC therapy in a post operative of wound. Material and method: A prospective study conducted in department of orthopaedic surgery, Grant medical college and sir JJ Group of hospital, Mumbai from 2016-2017. A total of 25 subjects were consecutively recruited. Patients included in study are classified according to the grade of the ulcer. Patients age group 21-70 years with the following risk factors and comorbidities diabetes mellitus, hypertension, chronic obstructive pulmonary disease, dyslipidaemia, and smoking. Post operative wound dehiscence of proximal tibia, distal tibia and olecranon selected. Pre and post VAC culture collected. Patients were evaluated post VAC after definitive management for functional outcome. Result: Our study of confirms that vacuum assisted closure is an excellent treatment modality for post operative wound dehiscence. Patients had an average of 8 treatment sessions. The duration of VAC application ranged from 12 to 36 days with an average hospital stay of 24 days. Amongst this maximum patients being in the age group of 30-70 years. VAC dressing found to produce more secondary closure of wound and split skin graft, also reduced more invasive procedures like flap surgery and in worst case amputation. Also it found reduces bacterial count of the wound. Conclusion: Promotes early rehabilitation, and alleviates the need for a second procedure. Significant reduction in hospital stay subsequent lower in hospital cost, decreased amputations, increasing the number of patients undergoing skin grafting and improving culture sterility.

Immediate application of vacuum assisted closure dressing over free muscle flaps in the lower extremity does not compromise flap survival and results in decreased flap thickness.

BackgroundFree muscle flaps are a mainstay for reconstruction of distal third leg wounds and for large lower extremity wounds with exposed bone. However a major problem is the significant postoperative flap swelling, which may take months to resolve. We studied the efficacy and safety of immediate application of a vacuum assisted closure (VAC) dressing after a free muscle flap to the lower extremity.MethodsOver a 19 months period, all consecutive free muscle flaps for lower extremity reconstruction at a Level I trauma center were evaluated prospectively for postoperative flap thickness, complications and flap survival. Immediate application of a VAC dressing was performed in 9 patients, while the flap was left exposed for monitoring in 8 patients.ResultsThere was no statistically significant difference in flap survival between both cohorts. Mean flap thickness at postoperative day 5 for the VAC group was 6.4±6.4 mm, while flap thickness for the exposed flap group was 29.6±13.5 mm. Flap thickness was significantly decreased at postoperative day 5 for the VAC dressing group.ConclusionsImmediate application of VAC dressing following free muscle flaps to the lower extremity does not compromise flap survival or outcomes and results in decreased flap thickness and a better aesthetic outcome.

Outcome analysis of vacuum assisted closure application in open fractures of long bones

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;We performed a prospective analysis&lt;strong&gt; &lt;/strong&gt;to&lt;strong&gt; &lt;/strong&gt;compare the efficacy of the&lt;strong&gt; &lt;/strong&gt;vacuum assisted&lt;strong&gt; &lt;/strong&gt;closure (VAC therapy)&lt;strong&gt; &lt;/strong&gt;and conventional cotton&lt;strong&gt; &lt;/strong&gt;gauze&lt;strong&gt; &lt;/strong&gt;dressing of&lt;strong&gt; &lt;/strong&gt;wounds.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;The study was conducted from July 2014 to&lt;strong&gt; &lt;/strong&gt;June 2016 on&lt;strong&gt; &lt;/strong&gt;patients admitted from&lt;strong&gt; &lt;/strong&gt;emergency department or presenting in the outpatient department of&lt;strong&gt; &lt;/strong&gt;the hospital. Necrotic tissues were debrided before applying VAC therapy. Dressings were changed every 3 or 4 days. For standard wound therapy, debridement followed by daily dressings was done. All patients&lt;strong&gt; &lt;/strong&gt;were&lt;strong&gt; &lt;/strong&gt;reconstructed with SSG/FLAP coverage after the granulation tissue was&lt;strong&gt; &lt;/strong&gt;sufficient. Two groups of 10 each compared prospectively. Data&lt;strong&gt; &lt;/strong&gt;were collected for&lt;strong&gt; &lt;/strong&gt;age, sex, time needed for sufficient granulation tissue for coverage, length of&lt;strong&gt; &lt;/strong&gt;hospital stay, no of debridements for VAC application and conventional gauze&lt;strong&gt; &lt;/strong&gt;dressings&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Time needed&lt;strong&gt; &lt;/strong&gt;to have a good&lt;strong&gt; &lt;/strong&gt;granulation&lt;strong&gt; &lt;/strong&gt;tissue sufficient for coverage, length of&lt;strong&gt; &lt;/strong&gt;stay in&lt;strong&gt; &lt;/strong&gt;hospital, and&lt;strong&gt; &lt;/strong&gt;no&lt;strong&gt; &lt;/strong&gt;of&lt;strong&gt; &lt;/strong&gt;debridements&lt;strong&gt; &lt;/strong&gt;were&lt;strong&gt; &lt;/strong&gt;significantly&lt;strong&gt; &lt;/strong&gt;less in&lt;strong&gt; &lt;/strong&gt;VAC&lt;strong&gt; &lt;/strong&gt;group. No major&lt;strong&gt; &lt;/strong&gt;complication occurred that&lt;strong&gt; &lt;/strong&gt;was&lt;strong&gt; &lt;/strong&gt;directly&lt;strong&gt; &lt;/strong&gt;attributable to&lt;strong&gt; &lt;/strong&gt;treatment. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Vacuum assisted wound therapy was found to facilitate the rapid formation of healthy granulation tissue on open musculoskeletal&lt;strong&gt; &lt;/strong&gt;injuries, shortens&lt;strong&gt; &lt;/strong&gt;hospital stay and minimize secondary soft tissue defect coverage procedures.&lt;/span&gt;&lt;/p&gt;&lt;p&gt; &lt;/p&gt;