Use Of VAC Therapy Research Articles

VAC Therapy as Part of Complex Treatment of Deep Sternal Wound Infection in Cardiosurgical Patients: First Experience

The aim. To improve the immediate and long-term results of treatment of cardiac surgery patients, by determining the feasibility of using wound therapy with negative pressure (vacuum assisted closure [VAC] therapy) as part of the complex tactics of postoperative management of patients with deep sternal wound infection (DSWI).
 Materials and methods. A single-center, retrospective, observational study of the clinical data of 12 patients who underwent open-heart surgery using median sternotomy and who developed a DSWI was conducted. The mean age of the patients was 66.2 ± 2.2 years. The patients were divided into 2 groups, depending on the type of the treatment they received: group 1 included 5 (41.67%) subjects with the installation of a flow-washing system; group 2 included 7 (58.33%) subjects receiving negative pressure wound therapy.
 Results. The use of VAC therapy contributed to the reduction of all indicators characterizing the course of the wound process, compared to patients treated with traditional methods. The duration of hospitalization was 36.2 ± 3.3 days in group 1 and 42 ± 4.0 days in group 2. The level of in-hospital mortality in the studied group receiving negative pressure wound therapy was 14.29% (1 patient) versus 80% (4 patients) in the group with flow-irrigation drainage.
 Conclusions. Deep sternal wound infection is a very serious postoperative complication in cardiac surgical patients with a high in-hospital mortality rate. Diabetes mellitus, obesity, immunopathies are the main risk factors. VAC therapy in patients with DSWI allows to adequately repair the wound in a shorter time while maintaining the patient’s mobility, as well as to significantly reduce the duration of wound drainage and, as a result, the length of hospitalization.

Эффективность лазерной терапии в комплексном лечении огнестрельных ран конечностей с обширным повреждением мягких тканей

The article presents comparative results of vacuum-assisted closure (VAC) and its combination with laser irradiation of the wound surface in the complex treatment of gunshot wounds of the extremities. The treatment results of 40 wounded patients with gunshot fractures of long bones of limbs were analyzed and divided into 2 groups: the 1st group (control group) included 20 (50%) wounded patients in whom VAC-therapy was administered alone; the 2nd group (comparison group) included 20 (50%) wounded patients who underwent VAC-therapy combined with narrow-band light irradiation with a wavelength of 980 nm. According to the results of the analysis of wound healing indicators and the number of complications, no statistically significant differences were found between the two groups. Based on the histologic examination, the 2nd group showed an accelerated onset of the regeneration phase in the form of more pronounced angiogenesis with the formation of granulation tissue and reduced inflammation. The duration of preparation of the gunshot wound for reconstructive-plastic defect replacement in Group 2 was by 7.1% shorter than in Group 1. Thus, the use of VAC-therapy in combination with laser irradiation allows to reduce the period of wound preparation for reconstructive-restorative surgery.

One-Stage Coverage of Leg Region Defects with STSG Combined with VAC Dressing Improves Early Patient Mobilisation and Graft Take: A Comparative Study.

Lower limb skin defects are very common and can result from a wide range of aetiologies. Split thickness skin graft (STSG) is a widely used method to address these problems. The role of postoperative dressing is primary as it permits one to apply a uniform pressure over the grafted area and promote adherence. Focusing on lower limb reconstruction, our clinical study compares the application of V.A.C. (Vacuum Assisted Closure) Therapy vs. conventional dressing in the immediate postoperative period following skin grafting. We included in the study all patients who received skin grafts on the leg region between January 2015 and December 2018, despite the aetiology of the defect. Only reconstructions with complete preoperative and postoperative follow-up data were included in the study. Patients were divided into two groups depending on if they received a traditional compressive dressing or a VAC dressing in the immediate postoperative period. We could retain 92 patients, 23 in the No VAC group and 69 in the VAC group. The patients included in the VAC group showed a statistically significant higher rate of graft take together with a lower immobilisation time (p < 0.05). Moreover, a lower rate of postoperative infection was recorded in the VAC group. This study represents the largest in the literature to report in detail surgical outcomes comparing the use of VAC therapy vs. conventional dressing after STSG in the postoperative management of lower limb reconstruction using skin grafts. VAC therapy was used to secure the grafts in the leg region, increasing the early graft take rate while at the same time improving patient mobilisation.

Вакуум-активна терапія у комплексному лікуванні постраждалих із вогнепальними пораненнями

VAC-therapy — сучасна новітня методика лікування ран, що значно поліпшує перебіг усіх стадій ранового процесу: зменшує локальний набряк, сприяє посиленню місцевого кровообігу, знижує рівень мікробного обсіменіння, призводить до відносно швидкого зменшення ранової порожнини, скорочуючи термін загоєння. Ціллю нашого дослідження було визначити клінічну ефективність використання VAC-therapy у лікуванні постраждалих із вогнепальними пораненнями. Для виконання нашого дослідження ми проаналізували лікування 74 постраждалих із вогнепальними пораненнями, що були отримані в результаті бойових дій, які лікувались у Військово-медичному клінічному центрі Центрального регіону в період 2015–2016 років. Проведене дослідження показало, що використання VAC-therapy є можливим у постраждалих із місцевими інфекційними ускладненнями вогнепальних поранень, значно покращує результати лікування ранового процесу у постраждалих із вогнепальними пораненнями, ускладненими гнійною інфекцією, що дозволяє рекомендувати VAC-therapy у клінічне використання.

SUCCESSFUL TREATMENT OF SEVERE PURULENT PERITONITIS WITH INTRAABDOMINAL HYPERTENSION COMPLICATIONS (CLINICAL CASE)

The widely used traditional method of surgical treatment of patients with widespread purulent peritonitis failed to establish itself as universal and has a large number of disadvantages, which prompts the use of new methods of managing patients in the postoperative period in surgical practice. The case described in the work illustrates the possibilities of a successful integrated approach in the treatment of diffuse purulent peritonitis against the background of Abdominal Compartment Syndrome, which includes the «Open abdomen» and «VAC-therapy» techniques, the use of which leads to a persistent decrease in both IАP and relief of the phenomena of purulent inflammation in the abdominal cavity.&#x0D; Conclusions. The use of VAC-therapy in combination with the «Open abdomen» technique leads to a persistent decrease in both ICP and relief of the phenomena of purulent inflammation in the abdominal cavity.

SURGICAL TREATMENT OF COMPLICATIONS AFTER STERNOTOMY

Summary. The article presents materials of laboratory and instrumental diagnostics of 44 patients with sternal osteomyelitis and comparative treatment with VAC - therapy and open method. Diagnosis was verified by multispiral computed tomography. Ultrasound showed the best results to control the cleaning and healing of sternotomy wounds. The bacterial spectrum showed a predominance of gram-positive microflora in 52.38 % of patients. The use of VAC therapy reduced the duration of hospitalization of patients from (20,3±2,7) to (13,6±5,8) days.&#x0D; Materials and methods. We analyzed the results of treatment of 22 patients who were treated at the State Institution “V.T. Zayceva IGUS NAMSU “in the period from 2014 to 2020 with osteomyelitis of the sternum (OS) after sternotomies. The material for the bacterial study was the isolation of a sternal wound. The antibiotic susceptibility of the isolated bacterial cultures was studied by disco-diffusion method and on agar. Diagnosis of multislice computed tomography (MSCT) was performed using Toshiba Aquilion 64 (Japan).&#x0D; Results and discussion. Wound infection was detected in 42 patients out of 44 examined. A total of 34 strains of microorganisms, representatives of different taxa. S. aureus was dominant and accounted for 23.81 % of the total number of isolates of this genus. In 14.28 % of cases there was contamination of S. epidermidis. E. coli and K. pneumonia 14.28 and 9.52 %, respectively. The most effective in vitro were lincomycin and especially carbopenems (imipenem).&#x0D; Among the instrumental studies we performed fistulography, ultrasound diagnostics (ultrasound) and MSCT.&#x0D; We used VAC therapy in 31 patients and in 13 patients by bandaging depending on the stage of the wound process. The duration was (4.7 ± 1.3) days.&#x0D; There was a decrease in the duration of wound cleansing: with superficial sternal infection — (12.8 ± 5.2) and (4.7 ± 1.3) days; with deep sternal infection — (25.3 ± 1.4) and (10.9 ± 2.2) days; term of hospitalization of patients with superficial sternal infection — (27.3 ± 5.6) and (13.6 ± 5.8) days; term of hospitalization of patients with deep sternal infection — (41.2 ± 3.5) and (20.3 ± 2.7) days.&#x0D; Conclusions. 1. In the diagnosis of OS should be preferred MSCT, which allows to verify the diagnosis in up to 99 % of cases, and the use of ultrasound to monitor the cleaning and healing of sternotomy wounds. The use of VAC therapy reduced the duration of hospitalization of patients from (20,3±2,7) to (13,6±5,8) days.

The microbiological profile of patients with Fournier's gangrene: A retrospective multi-institutional cohort study.

To evaluate the role of the microbiological profile and of disease-related factors in the management of patients affected with Fournier's gangrene (FG). Data regarding patients admitted for FG at nine Italian Hospitals (March 2007-June 2018) were collected. Patients were stratified according to the number of microorganisms documented: Group A - one microorganism; Group B - two microorganisms; Group C - more than three microorganisms. Baseline blood tests, dedicated scoring systems, predisposing risk factors, disease's features, management and post-operative course were analyzed. UpSet technique for visualizing set intersections in a matrix layout and Cuzick's nonparametric test for trend across ordered groups were used. Eighty-one patients were available for the analysis: 18 included in Group A, 32 in Group B, 31 in Group C. The most common microorganism isolated was Escherichia coli. In Group B-C, Escherichia coli was often associated to Enterococcus faecalis, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Statistically significant positive association was highlighted among the number of pathogens (Group A vs B vs C) and serum C-reactive Protein (p < 0.001), procalcitonin (p = 0.02) and creatinine (p = 0.03). Scoring systems were associated with the number of microorganisms detected (p < 0.02). A significant association between the number of microorganisms and the use of VAC therapy and need of a fecal diversion was found (p < 0.02). The number of microorganisms was positively associated with the length of stay (LOS) (p = 0.02). Ten weeks after initial debridement, wound closure was achieved in 11 (91.7%), 22 (84.6%) and 20 (80%) patients in Group A, B, and C, respectively, with no differences in overall survival. Polymicrobial infections in FG are positively associated with inflammatory scores, the need for fecal diversion and the LOS. This results may help the counseling and the clinical management of this rare niche of patients.

OSTEOMYELITIS OF STERNUM: DIAGNOSIS AND SURGICAL TREATMENT

Postoperative sternomediastinal infections significantly affect morbidity and mortality, as well as the hospitalization duration and treatment cost for cardiac surgery patients. The use of median sternotomy has a number of complications, primarily infectious, which can occur with the formation of superficial or deep wound infection, diastase and fragmentation of the sternum, and sometimes with destabilization of the chest bony skeleton. The development of sternal osteomyelitis is associated with a significant reduction in long−term survival. The results of treatment for the patients with the sternum osteomyelitis after sternotomies, being at the State Institution "V. T. Zaitsev Institute of General and Emergency Surgery of the NAMS of Ukraine" in Kharkiv within the period of 2014−2020, have been analyzed. Diagnosis of patients with osteomyelitis of the sternum comprised fistulography, multispiral computed tomography, ultrasound. The material for the bacterial study was the discharges of a sternal wound. Antibiotic susceptibility of isolated bacterial cultures was studied by disco−diffusion and in agar. There were 32 strains of microorganisms, representatives of different taxa. S. aureus was dominant and accounted for 23.81 % of the total number of isolates of this genus. Among antibiotics, the most effective in vitro were lincomycin and especially carbapenems (imipenem). When treating the patients with sternal osteomyelitis, VAC therapy was used, as well as open wound management by dressings depending on the wound process stage. The results of the study suggest that multi−slice computed tomography should be preferred in the diagnosis of osteomyelitis of sternum, which allows the diagnosis verification in 98 % of cases, and the use of ultrasonography is important to monitor the clearance and healing of sternotomy wounds. The use of VAC therapy has helped to reduce the length of hospital stay of patients. Key words: sternum osteomyelitis, VAC therapy, multispiral computed tomography, bacterial culture.

Vac-therapy in the management of tension pneumomediastinum and subcutaneous emphysema

Pneumomediastinum and subcutaneous emphysema are the main manifestations of gas syndrome in patients with tracheal injury. Traditional mediastinal decompression in case of tension emphysema is carried out through different types of cervical or transpleural mediastinotomy and subsequent passive drainage. Clinical observation of the use of VAC-therapy in the patient with injury of the membranous part of trachea followed by tension pneumomediastinum is presented. Cervicotomy with dissection of anterior mediastinum and installation of vacuum-assisted dressing were performed. Fast regression of subcutaneous emphysema and relief of pneumomediastinum were noted. There were no complications. The patient was discharged in 6 days after admission. Effectiveness of VAC-therapy in patients with tension subcutaneous emphysema and pneumomediastinum was confirmed.

APPLICATION OF VAC-THERAPY IN THE TREATMENT OF DIABETIC FOOT

The aim. To substantiate the effectiveness of the use of VAC-therapy in the treatment of wounds in patients with diabetic foot syndrome. Materials and methods. The patient with a complicated form of diabetic foot syndrome was examined. The monitoring of the course of the wound process is supplemented by clinical, cytological, microbiological and morphological criteria. In the treatment of patients we used vacuum therapy apparatus. Vacuum wound therapy was performed in negative pressure regimens in the range of 80–125 mm Hg. Results. In the pattern of morbidity in economically developed countries, diabetes mellitus (DM) occupies one of the first places. Its prevalence is 1.5–6 %. The number of patients with diabetes in Ukraine is likely to reach 14 million by 2020. Lesions of the lower extremities of different genesis occur in 30–80 % of people with impaired carbohydrate metabolism. Most often, these lesions are complicated by the development of chronic peptic ulcer defects, which, when untimely diagnosed and inadequate treatment, leads to amputation of the affected limb. Even when radical surgery is avoided, the long and costly treatment of trophic disorders of the soft tissues of the feet and legs leads to huge costs of both material resources and time for medical staff. In 15 % of patients with DM, trophic ulcers of the lower extremities are diagnosed. Recent studies have focused on such important aspects of the study of this issue as the early diagnosis of soft tissue lesions in individuals with DM, the development of treatment aimed at preventing amputations, facilitating the further rehabilitation of patients. Vacuum therapy is one of the new methods of treating wound defects, including in patients with diabetic foot syndrome. Topical application of vacuum therapy has already become an integral therapeutic option for wound debridement in patients with diabetic foot syndrome. However, when applying the classic vacuum therapy technique, these patients have the problem of delaying the outflow of tissue exudate and lysis detritus to the vacuum system. Conclusions. Optimization of the technique of the influence of negative pressure on the wound by applying forced drainage with irrigation of the wound with an antiseptic can maintain a constantly high concentration of antimicrobial agent in the wound, increase the speed of wound dialysis and prevent clogging of pores of the sponge and the bacterial colonies in it. The application of this technique avoids high amputation, accelerates the time of wound healing, and retains the supporting function of the lower extremity.

Application of vacuum wound therapy with split thickness skin grafts in the head and neck area

In vacuum wound therapy (VAC) a negative pressure can continuously clean effusions and enhance the formation of granulation tissue significantly. In visceral, trauma and burns surgery this technique is used frequently in critical wounds. In the head and neck area there is limited experience and publications. Especially in the combined use of split-thickness-skin grafts (STSG) and VAC there is no published evidence. A retrospective database analysis was done and resulted in 36 single VAC therapies in 13 patients. They were treated between 2012 and 2017 in the Department of Otorhinolaryngology of the University Medical Center Ulm, Germany. A data analysis was performed relating to indications, diagnoses, comorbidities as well as the clinical course and outcome with special focus on STSG. Besides classical indications as pharyngo-cutaneous fistulas and troublesome would healing after flap surgery, 7 cases of VAC use with split-thickness skin grafts were identified. The median treatment duration was 11 days, the VAC dressing was changed twice in average, the median negative pressure was 70 mmHg. Wound closure was successful in 13/13 cases, in 7/13 cases wound closure was achieved by split-thickness skin graft with synchronous VAC therapy, 4/13 cases showed healing by secondary intention, in 2/13 cases a local or distant flap was used. We first describe the successful use of VAC therapy in combination with STSG in the head and neck area. This was effective in radiated patients and in critically ill patients with sepsis and necrotizing fasciitis.

Deep postoperative spine infection treated by negative pressure therapy in patients with progressive spinal deformities.

The aim of the study is to review the outcome of using the VAC system in children and adolescents who have developed postoperative spinal infection after posterior instrumented spinal fusion, and to evaluate whether this technique is also feasible in patients treated with posterior instrumented fusion with polyester sublaminar bands. A total of 11 out of 118 consecutive children and adolescents (5 males) with deep postoperative spinal infection were identified; infections were categorised as early (acute), delayed (subacute) or late (chronic) according to time of onset. Irrespective of the etiology and the onset, all the deep infections were managed with the reported technique. All the patients had regular clinical and radiological follow-up. Eight out of 11 patients developed an early (72.7%), 2 a delayed (18.2%) and 1 a late deep postoperative infection (9.1%); 7 out of 11 (63.6%) showed severe mental compromise. No statistically significant differences were observed for mean number of VAC dressing changes (p = 0.81) and mean length of hospitalisation comparing patients with early infection versus patients with delayed or late infections (p = 0.32). Mean number of VAC dressing changes (p = 0.02) and mean number of hospitalisation days (p = 0.05) were higher in patients with underlying neurological disorders than in those without, while mean length of hospitalisation was longer in neuromuscular patients. The application of the VAC system, as an adjunct to surgical debridement and adequate antibiotic therapy, is a reliable method for the treatment of postoperative infection in children and adolescents undergoing spinal instrumentation and fusion. It can reduce the need for further complex soft-tissue procedure, removal of hardware with consequent loss of correction, and pseudoarthrosis. Finally, the use of VAC therapy is not contraindicated in patients treated with hybrid constructs with sublaminar bands. III.

Staged isolation of abdominal cavity in generalized on peritonitis.

In the work we present comparative results of treatment of patients with generalized secondary and tertiary peritonitis depending on the way of surgery completion. Patients in group I (n=27) underwent only skin suturing after the surgery, in group II –laporostoma was formed with VAC in the abdominal cavity. We have evaluated the level of microbe contamination and condition after wound surgery, intensity of adhesion process in the abdominal cavity, multiple organ failure after surgery. The use of laporostoma combined with VAC at different stages of generalized peritonitis treatment helps to achieve illness rigress, less number of planned saniations of abdominal cavity. Even after the first use of VAC, quicker clearance of operation wound and appearance of new granulation tis­sues occurred. In group II in secondary saniation the frequency of fixing of abdominal cavity is developing 31,9% higher (p&lt;0,05) and in the third saniation the use of VAC therapy resulted in growing number of patients with frozen abdomen.

EComment. Vacuum-assisted closure therapy in cardiac surgery

The retrospective study by Vos et al. has reported on the superiority of VAC-therapy compared to open packing in patients with post-sternotomy mediastinitis (PM) [1]. We have reviewed our experience regarding the management of deep sternal wound infections (also commonly called PM) in 85 patients over a period of 11 years (2000–2010) where the in-hospital mortality rate for this specific group was 7% vs. 3% . The higher logistic EuroSCORE for these patients (10.2% vs. 7.9%) indicates the higher rate of preoperative co-morbidities [2]. Our therapeutic approach is consistent with immediate application of VAC-therapy plus systemic antibiotics even when there is no clear distinction of whether there is an infective deep sternal wound or not [2]. This approach may improve the wound healing process through the early removal of the infective tissues and reduction of dead space. In case of sternal dehiscence, further surgical revision is required. Upon resolution of acute infection and confirmation of wound cultures as negative, a primary sternal closure technique is applied followed by insertion of closed irrigation - suction drains [2]. Bilateral myocutaneous pectoral flap reconstruction can be performed when necessary with particular emphasis on the preservation of its vascular supply. Six percent of these patients required a further plastic intervention [2]. In 2003, Luckraz et al. found that VAC-therapy combined with primary closure or myocutaneous flap is superior to VAC-therapy alone in patients with PM (VAC duration 13.5 days vs. 8 days, healed scar 77% vs. 64%, mortality rate 7.7% vs. 28.6%) [3]. The overall cost of the VAC-therapy per patient was regarded as nearly $4000 cheaper per patient than the single use of a closed irrigation system [3]. Pectoralis flaps can frequently be used for the definitive treatment of PM and the final sternal reconstruction. These flaps, as described by Jurkiewicz et al., allow early closure and healing of sternal wounds and are currently the conventional treatment for PM [4]. Alternatively, omental flaps can also be used for the treatment of PM specifically in the case of replacement of the ascending aorta with a prosthetic graft [4]. In 2007, Raja and Berg published their meta-analysis regarding the routine use of VAC-therapy in all patients with deep sternal wound infections post cardiac surgery. The authors identified 13 papers (out of 198) representing the best evidence in the use of VAC-therapy [5]. All the studies were retrospective or small cohort and the largest one was by Agarwal et al. with 103 patients (64% had the definitive diagnosis of PM) [5]. According to Agarwal et al., all the patients were treated with VAC-therapy (average period 11 days/patient) of whom 68% had definitive chest closure. The overall mortality rate was 28%, however, no deaths were related to VAC-therapy. Four deaths were due to PM sepsis [5]. This meta-analysis illustrates that VAC-therapy is a safe and effective additional method for the surgical management of PM. However, a prospective double-blinded randomized controlled trial is essential in order to validate the effectiveness, cost effectiveness and improvement of quality of life of patients undergoing VAC-therapy [5]. Conflict of interest: none declared.

Traumatic hemipelvectomy: Improvements in the last decennia illustrated by 2 case reports

INTRODUCTIONIn this article we present two cases of young men who sustained a traumatic hemipelvectomy. PRESENTATION OF CASEThe first case occurred more than 10 years ago and the second case happened less than 1 year ago. Changes in the management for resuscitation, surgical intervention, and in postoperative treatment are detailed. Goal of this article is to evaluate the changes over time in the treatment of trauma in general and this specific injury in particular. DISCUSSIONMaximum survival chance could be achieved by an aggressive resuscitation (following a massive transfusion protocol-ratio of 1:1:1 unit of blood-products), starting pre-hospitally and continued in the emergency department, immediate control of the haemorrhage and direct surgical intervention. Early and frequent re-explorations are necessary to prevent complications as sepsis and to minimize the chance for complications such as disturbed wound healing and fistula formation. The use of the Vacuum-Assisted Closure therapy nowadays gives the patient an earlier recover and lesser chance at developing complications. Early consultation with plastic surgeons needs to be done in order to achieve an adequate definitive wound-closure (reconstructive surgery). CONCLUSIONA traumatic hemipelvectomy is a catastrophic and mutilating injury, seldom survivable. Maximum survival chance could be achieved by an aggressive resuscitation, frequent re-explorations, the use of VAC therapy and early consultation with a plastic surgeon for reconstructive surgery.

Use of Vacuum-assisted Closure in Pediatric Open Fractures With a Focus on the Rate of Infection

The use of the vacuum-assisted closure device (VAC; KCI, San Antonio, Texas) has given the orthopedist a new tool for the successful management of severe traumatic wounds and open fractures. While the VAC's role in the adult population is proving itself as an improved therapy compared to "traditional wound care," it's role within pediatric orthopedics remains less well defined. Questions remain whether VAC therapy provides benefit regarding decreased infection rates as well as decreased need for extensive soft tissue coverage procedures. A review was therefore performed of a pediatric level I trauma center's experience using the VAC therapy for pediatric open fractures with a focus on the rate of superficial, deep, and chronic infection. A retrospective chart review spanning 4.5 years of all pediatric patients younger than 18 years with an open fracture initially treated with VAC therapy was conducted at a level I pediatric trauma center. This yielded 28 patients with 37 open fractures aged 2 to 17 years who were initially treated with wound VAC therapy. Subsequent chart review of these patients was performed examining in-hospital records, operative notes, and clinical follow-up visits for documented cases of superficial, deep, or chronic infection. Of 37 open pediatric fractures treated with a wound VAC, there were no cases of superficial infection and 2 cases of deep infection for an overall infection rate of 5%. Both infections resolved with surgical intervention and antibiotics without chronic infection development. When compared with historical controls, the use of VAC therapy for pediatric open fractures appears to be an equally safe and effective modality to help reduce infection in pediatric open fractures and should be considered a valuable tool in treating these injuries.

Rare complication after VAC-therapy in the treatment of deep sore ulcers in a paraplegic patient

The VAC-therapy is a safe, easy, and effective therapy for the management of chronic wounds. Known advantages of the VAC technique are the quicker wound healing by stimulating the blood flow, the formation of granulation tissue, angiogenesis, and cell proliferation. The use of negative pressure treatment can decrease the number of dressing changes and length of hospital stay. However, some related complications after and during VAC therapy have been described. We here describe a rare complication during the treatment of severe os ischium sore with VAC therapy, which has not been reported in the literature yet. We report about a 43-year-old paraplegic patient, referred to our clinic from a regional hospital where he had been admitted 2 months earlier, presenting with a necrotizing fasciitis after VAC therapy during the treatment of fourth grade os ischium sore. After operative debridement and long-term antibiotics with Ciprofloxacin soft tissue closure was performed using a myocutaneous tensor fascia lata flap. Temporary stabilization was achieved by a triangle external fixateur attached to the right femur and the pelvis. After 1 week the tapping point of the muscle flap could be covered with local skin mesh-graft from the right calf as a donor site. The patient was mobilized in a wheelchair and was discharged home 3 months after admission. The VAC technique is a safe, easy, and effective means in chronic wound care management. However, the described rare complication should be kept in mind. The clinical management of VAC therapy requires a distinct indication and close clinical monitoring by experienced medical professionals. The use of VAC therapy in fourth grade sores may have deleterious consequences for the patient.

Vacuum Assisted Closure® therapy in the treatment of mesh infection after hernia repair

Mesh related infection after prosthetic abdominal wall hernia repair is a difficult clinical problem, particularly in an era of evolving microbial resistance. Commonly advocated treatment for such infection involves complete mesh excision which usually leaves a complicated weak wound. We report the use ofVAC therapy for mesh infections that allows mesh preservation leaving a sound wound. From june 2002 to January 2007, four patients with mesh related infection after abdominal wall hernia repair were treated with VAC therapy. Patients' notes were reviewed to gather clinical details. Mesh infection was evident after a variable period (day three to eight years) following hernia repair. Of the four patients, one had infection with methicillin resistant Staphylococcus aureus (MRSA), while the bacteriological cultures from two confirmed Staphylococcus aureus in one and a mixture of Pseudomonas and enterococcus species in the other. One patient failed to show significant bacterial growth on pus swab culture, having had prior broad-spectrum antibiotic treatment for mesh infection. Three patients had complete mesh preservation and one had partial mesh excision. All patients were treated with VAC therapy, following the drainage of their operation sites, until the visible mesh was covered with granulation (one to seven weeks). No patient had a recurrent hernia after complete wound healing. VAC therapy allows salvage of infected exposed mesh by promoting granulation through the mesh. Judicious use of VAC therapy may prevent the need of mesh excision and its wound related complications.

Use of Vacuum Assisted Closure in Vascular Graft Infection Confined to the Groin

Purpose: In this report we share our experience with the use of the VAC system as a less invasive means of graft preservation and an effective alternative to routine muscle flap closure, in patients with groin wound healing complications following lower limb vascular procedures. We also review the English literature regarding the use of VAC therapy on infected groin wounds when the infection affects the prosthesis.Patients and Methods: eight patients treated with delayed healing of a groin incision following a femoral artery surgery. In six cases local exploration or CT examination showed evidence of graft involvement (Szilagyi grade III). Results: Mean duration of VAC use was 21.5 days (range, 10 to 45). The wounds were filled with granulation tissue by day 10 with no purulent-inflammatory exudates. At the end of VAC therapy, final closure was easily achieved by either healing by secondary intention or delayed primary closure. No patient required use of muscle flaps. There were no reinfections at 1 to 28 month follow-up (mean, 17.2 months/one case lost to follow-up).Conclusion: Our initial experience with VAC therapy to treat non healing groin wounds following vascular reconstructions is very promising. Negative pressure therapy resulted in control lymph leakage, achieving healing and managing infection.