VAC Device Research Articles

The Application of Double-Layer-Vacuum-Assisted Closure Therapy With Flap Repair of Soft Tissue Defects Near the Eyes or EarDL-VAC Therapy.

We aimed to introduce and evaluate the safety of double-layer-vacuum-assisted closure (DL-VAC) therapy with flap repair of the wound near the eyes or ears. This study is case reports of 2 patients who underwent DL-VAC therapy for tissue defects near the eyes or ears. The detailed process of the DL-VAC therapy is carefully described in this study. The postoperative wound healing process was closely observed. The biggest concern was the treatment outcome of DL-VAC therapy on the eyes and ears. Two patients underwent DL-VAC therapy due to their soft tissue defects close to the eyes or ears. Both patients achieved primary wound healing and the flaps survived during the follow-up period, which ranged from 1 to 24 months. Patients did not receive any dressing change until the VAC device was removed on the 5th to 7th postoperative day. No severe complications appeared and the patients were satisfied with both appearance and function. Double-layer-vacuum-assisted closure therapy is an effective and safe option for the treatment of wounds near the eyes and ears.

602 Using Plastic Surgery Techniques in Abdominal Wall Surgery

Abstract Complex Abdominal Wall Hernias (CAWH) present a huge challenge to surgeons and patients often requiring Abdominal Wall Reconstruction (AWR). AWR aims to restore abdominal wall anatomy, improve function, and reduce the risk of future herniation. Plastic surgery techniques can be used including primary closure, skin grafts, flaps, tissue expansion and small bite, small stitch technique. Below are two cases where some of these techniques were utilised. Case 1 LC is a 65 y/o female with CAWH. Her gastric band became infected requiring a laparotomy for perforation of gastroesophageal junction. She subsequently had primary open repair of abdominal hernia using Permacol. It became infected requiring 5 debridements and application of a VAC device. Her hernia was a Ventral Hernia Working Group (VHWG) grade 3 at 10cm×16cm. Her CAWH was repaired using a Rives-Stoppa technique and a Surgimend mesh. The epigastric component of her wound was closed using a superiorly based local rhomboid flap and a Prevena VAC dressing. Case 2 KH is a 37 y/o female with a para-ileal conduit skin granuloma that was painful and refractory to other treatments such as silver nitrate and steroid topical treatments. She had excision of the area of granulation and her wound was closed using a local advancement flap taking account of previous scars raised and a prevena VAC dressing. Discussion CAWH requiring AWR is a complex operation benefiting from plastic surgical specialists. Plastic surgical techniques can help with closure of the abdominal wall and reduce complication rates including wound infections and incisional hernia.

Management of a Postoperative Orocutaneous Fistula with Transoral Negative Pressure Therapy

Orocutaneous fistulas are a common problem in head and neck reconstruction and can be a challenge to manage. They result in persistent wound drainage, poor healing, and delay in adjuvant therapy and may precipitate flap failure. Negative pressure wound therapy offers several benefits, including increasing granulation tissue formation, promoting wound contraction, and removing moisture to promote fistula closure. Its use in head and neck reconstruction has few documented attempts in the literature for managing complicated intraoral wounds. The goal of this study was to establish feasibility and efficacy of an intraoral NPWT for management of post-surgical orocutaneous fistulas.The patient was a 73-year-old female with a history of pT2N0M0 squamous cell carcinoma of the left buccal mucosa who had previously undergone primary resection and reconstruction with a parascapular free flap with adjuvant radiation. Ten years following her original treatment, she developed osteoradionecrosis with an orocutaneous fistula and a pathologic fracture. She underwent a segmental mandibulectomy and reconstruction with an osteocutaneous free flap.She had an uneventful postoperative course and was discharged on day 6. One-week post-discharge, the native oral mucosa overlying the fibula flap had broken down, and a significant orocutaneous salivary leak was present (Figure 1). Given the proximity of the salivary collection to the pedicle, there was concern this would compromise the anastomosis and result in flap loss. Any surgical intervention to correct the problem would require extensive remobilization of the existing inset or elevation of a second soft-tissue flap. Thus, the decision was made to pursue an alternative novel treatment option.Impressions were obtained and a stone model poured to fabricate an acrylic splint that could support the negative pressure device (Figure 2). The stent was relined with polyvinyl siloxane impression material to ensure adequate seal against the mucosa. The intraoral appliance would not initially hold suction because of the air leak from the cutaneous portion of the fistula, so a VAC sponge was adapted and a Y-connector was used to apply negative pressure to both sites simultaneously.The patient was able to tolerate wearing the device around the clock as continuous suction was able to be maintained. She followed up every third day to change the VAC dressing and to make adjustments as needed. She continued to be fed via Dobhoff tube during this period.On follow-up 2 weeks later, the patient had significant granulation tissue formation in her intraoral wound with almost complete closure.At this point, the intraoral device was discontinued, but the VAC dressing on the neck was maintained for an additional 2 weeks until the intraoral component of the fistula had closed completely and was no longer able to be probed (Figure 3).The principle aim of this study was to determine the efficacy and practicality of an intraoral wound VAC device in the management of an orocutaneous fistula. There was a positive benefit to healing of the orocutaneous fistula for this patient, as she had dramatic granulation tissue formation within 2 weeks of using the device. An intraoral wound VAC device seems a viable option for acute management of orocutaneous fistulas in select patients. The use of such a device would require significant patient compliance and commitment as well as technique sensitive dressing application that may not be suitable in all cases.

The safety and efficacy of using negative pressure incisional wound VACs in pediatric and neonatal patients

BackgroundSurgical site infection (SSI) rates are an important surgical quality metric. Decreased SSI rates have been demonstrated using negative pressure incisional wound vac device (NPIWV) dressings in adults but have not been studied in children. Materials and methodsA retrospective review of patients treated with NPIWV at our institution between February 2016 and February 2018 was performed. NPIWV dressings were applied by previously described techniques. Using the same CPT codes from our study patients, we queried the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) data between January 2014 and January 2016 to identify preimplementation controls (PIC). NPIWV patients were compared to historical controls to assess safety and efficacy of SSI prevention. ResultsThere were 32 patients managed with NPIWV, and 65 patients in the PIC group. There were no NPIWV-associated complications. There was a trend toward reduced incidence of SSI in NPIWV patients, with 1 SSI in 32 cases (3.1%) versus 7 SSIs in the 65 historical control patients (10.8%) (p = 0.22). ConclusionsOur study shows that NPIWV dressings can be used safely in pediatric and neonatal patients undergoing surgery, with a trend toward decreased SSI rates. These findings should be confirmed in a larger, prospective trial. Type of studyRetrospective comparative study. Level of evidenceLevel III.

PS01.183: ENDOSCOPIC TREATMENT OF ESOPHAGOGASTRIC ANASTOMOSIS FISTULA AFTER MINIMALLY INVASIVE ESOPHAGECTOMY: REPORT OF THREE CASES AND REVIEW OF THE LITERATURE

Abstract Background Anastomotic leaks after esophagectomy can lead to severe complications and account for 40% of postoperative deaths. During the last decades, several types of endoscopic treatments have became available, such as the use of esophageal stent and the use of vacuum therapy. In this paper we report one case of cervical anastomotic fistulas after esophagectomy treated with vacuum therapy and two cases treated with stent. Methods Three cases of cervical anastomotic fistulas after esophagectomy treated with an endoscopic aproach (stent and vacuum therapy) are reported. Results Case 1 61-year-old male with an mid-esophagus adenocarcinoma was treated with neoadjuvant chemotherapy and minimally invasve esophagectomy. On the 10th post-operative day (POD) a partial dehiscence of the anastomosis with communication with the mediastinum was identified, forming a cavity with a large amount of purulent secretion. A sponge attached to a nelaton probe, similar to the VAC device, was positioned inside the mentioned cavity and coupled to a continuous aspiration system. There was a gradual clinical improvement and on the 30th POD the sponge was finally removed. The patient was discharged on the 50th POD. Case 2: A 62-year-old male with a adenocarcinoma in the thoracic esophagus received neoadjuvant chemoradiotherapy and a minimally invasive esophagectomy. On the 7th POD, an anastomotic fistula draining by the chest tube was diagnosed. A stent that was positioned over the fistula area. The patient was discharged on the 28th POD with the stent, that was removed six weeks later. Case 3: 58 years old male patient presented with a superficial squamous cell carcinoma of the mid-thoracic esophagus. A minimally invasive esophagectomy was performed.On the 7th POD, a EGD was performed and showed a fistulous orifice in the esophagogastric anastomosis. A metal stent that was positioned over the fistula area. The patient evolved with empyema and a pulmonary decortication was performed by on the 17th POD. After progressive clinical improvement he was discharged on the 34th POD. Conclusion Esophageal stent has been successful used in treating this surgical complication. Recently, VAC therapy, is becoming an promising therapy for this complication, with lower morbidity and mortality rates and greater success in the closure of the anastomotic fistula when compared to the esophageal stent. Disclosure All authors have declared no conflicts of interest.

Comparison of Negative Pressure Wound Therapy (NPWT) Using Polyvinyl Alcohol (PVA) Sponge with Advanced Wound Dressings

Objective: The primary purpose of this study is to compare appearance of granulation tissue, rate of wound infection, period of hospital stay and duration for complete wound healing using two different methods of wound dressing at secondary healthcare centres. Material and Methods: 127 patients between the age group 14-68 years with an average age of 42 years were included in this study. Out of these 127 cases, 1 died due to urosepsis with severe lung infection and 6 cases did not turn up for follow up treatment. The remaining 120 cases were divided into two groups i.e. A and B. Group A was subjected to modified negative pressure wound therapy (NPWT) using sterilized polyvinyl alcohol sponge as an alternative to standard Granu Foam. A Ryle’s tube with additional pores were created and interposed between the PVA sponges. The Ryle’s tube was attached to the suction drain and another end of the suction drain connected directly to wall suction which is programmed to produce a pressure of 125 mmHg. At the end of 72 hours, a new cycle was repeated. Group B was subjected to daily dressing with advanced wound dressings (dermacyn and solcoseryl gel). Results: Statistically better result was obtained in favour of NPWT for wound dressing. The appearance of granulation tissue was more rapid in group A patients. The infection rate of group A patients was very low when compared to group B patients. The mean time (duration) to complete healing was faster in Group A, however the mean length of hospital stay was longer as compared to group B patients. Conclusion: Healing is more rapid with less infection rate in NPWT group compared to advanced wound dressing group. NPWT using wall suction and PVA sponge can be performed in secondary healthcare centres with low resources as well as for patients who could not have afforded charges of commercially available standard VAC device or advance wound dressings.

The oval sponge: a simplified method for scrotal skin graft fixation using VAC device

The oval sponge: a simplified method for scrotal skin graft fixation using VAC device

Working with a wound VAC device

Davis, Charlotte BSN, RN, CCRN; Waters, James III RN; Brothers, Kandie MSN, RN, CNL Author Information

Managing Acute Wounds with Negative Pressure System in a Developing Country

Introduction. The negative pressure system has been found to be a valuable addition to the various procedures of wound management and has been widely accepted to be safe and effective in promoting wound healing. Aim. The study seeks to find out the outcome of the use of the VAC device in the treatment of patients with acute wounds. Materials and Methods. Between January 2009 and December 2011, a consecutive nonrandomized study was conducted among 48 patients who presented with acute wounds at the Komfo Anokye Teaching Hospital. Patients were made to undergo negative pressure wound therapy using the VAC device. Results. Forty-eight patients with various degrees of acute wounds were treated, of which 43 (89.6%) were females and 5 (10.4%) were males. Ages of patients ranged from 19 to 78 years. Satisfaction with rate of wound healing revealed that 86.7% and 8.9% had excellent and good healing, respectively, while 4.4% said theirs was satisfactory. Therapy was discontinued in three (6.3%) patients who developed some complications. Conclusion. There was reduction in the hospitalization by patients thereby reducing costs. Also, quality of life of persons who had undergone the therapy with the VAC device had improved. Even though a few device-related complications were observed, patient satisfaction was high.

The VAC-Basket for Easy Fixation of Scrotal Skin Grafts

The vacuum assisted closure (VAC, Kinetic Concepts, Inc., San Antonio, TX, USA) device has revolutionized wound management in recent years due to its ability of exudate clearance, tissue granulation induction and edema reduction [1]. It also has been shown very beneficial in aiding skin graft take in difficult anatomical regions [2]. Fournier's gangrene is characterized by perineal tissue necrosis caused by bacterial infection. Therapy usually consists of wide debridement together with appropriate antibiotic drug administration to reduce bacterial burden and control infection. After the initial debridement, the reconstructive surgeon faces large raw surface areas in the perineogenital region that have to be covered. This typically can be achieved by skin grafts or local flaps. Due to the three-dimensional character of this region, fixation of the skin graft may be difficult and hinders therefore optimal graft take. In such difficult cases, the VAC device has been utilized as the optimal initial wound dressing [3,4]. Here we want to present our modification for easy fixation and application of a skin graft in scrotal reconstruction after Fournier's gangrene. A 54-year-old patient was admitted to our Urology department for treatment of a massive soft tissue infection in the perineogenital region. After initial debridement and antibiotic therapy, the patient presented to our department with a global skin defect over the scrotum that was well granulated. The decision was made in favor of skin graft reconstruction. To enhance graft fixation, we constructed our VAC-basket out of a regular commercially available VAC-Granu Foam medium dressing kit (Figs. 1, ​,2).2). The unmeshed skin graft was harvested from the right lateral thigh region and was initially fixed with multiple interrupted 4-0 Polysorb (Covidien, Mansfield, MA, USA) sutures. Then, the wound edges were secured with double-sided adhesive hydrogel strips (VAC gel). Now, the VAC-basket was snugly fit over the skin-grafted scrotum und fixed with some skin staples. Finally, the dressing was completed with drapes and the SensaTRAC-pad. The dressing was left in place for 5 days and then completely removed. Skin graft take was excellent (Figs. 3-​-5).5). We were able to discharge the patient, who was instructed in further local wound care, after another 3 days from our unit. Fig. 1 Creation of the VAC-basket out of a regular VAC GranuFoam dressing. The Foam is first cut in the upper third in a horizontal plane and the lower two-thirds are brought together in the median just as small flaps and secured with simple skin staples. ... Fig. 2 The next step involves trimming of the upper flaps so that a triangular flap remains which allows for closure of the basket and forms the bottom of the VAC-basket. Fig. 3 The patient presented with a global skin defect over the scrotum after debridement from Fournier's gangrene. Defect coverage was achieved with an unmeshed split-thickness skin graft. Fig. 5 At two-weeks follow-up there was excellent graft take. We here describe a useful application and modification of the VAC-system for easy fixation of skin grafts in the scrotal region. The usefulness of the VAC system in the perineogenital region has been described in the past [3,4]. However, applying the VAC sponge to this often-difficult area is tedious. Our modification is novel in so far, that a basket is created out of a regular VAC sponge in order to hold the scrotum and its attached skin graft. The VAC-basket further expands the clinical utilization of the very useful VAC-therapy.

Prospective randomized controlled trial comparing two methods of securing skin grafts using negative pressure wound therapy: VAC and GSUC

Introduction Negative pressure wound therapy (NPWT) revolutionized complicated wound management and contributed a new modality for securing skin grafts. However, the industry standard in NPWT, the VAC device, has limited accessibility due to the cost of utilization. In the past decade, we accumulated experience using gauze sealed with an occlusive dressing and wall suction (GSUC) as our primary method for NPWT. We now report a randomized controlled trial comparing the efficacy of GSUC versus VAC in securing skin grafts. Methods 81 wounds requiring split thickness skin grafts were prospectively enrolled from August 2009 to February 2011 and randomized to VAC or GSUC. Wounds were assessed 4 to 5 days postoperatively for adherence and re-evaluated 7-18 days postoperatively for graft take. Study failures and reoperative rates were reviewed. Results 42 wounds and 39 wounds were randomized to the GSUC and VAC study arms, respectively. Patient demographics were similar between groups. Wound size averaged 238 cm2 and received 4.39 days of NPWT. Skin graft take averaged 97.8% (p=0.03) for GSUC and 97.3% (p=0.04) for VAC. Reoperation was required for one wound in the VAC arm and three wounds in the GSUC arm. Two wounds were study failures due to loss of suction by the VAC system. Both wounds were salvaged by conversion to wall suction. Conclusions NPWT is a useful method for promoting adherence and healing of skin grafts. We demonstrate that a low cost, readily accessible system utilizing standard gauze dressings and wall suction (GSUC) results in comparable skin graft take to the VAC device.

Intrathoracic Insertion of the VAC Device in a Case of Pleural Empyema 20 Years After Pneumonectomy

We report a 72-year-old man suffering from pleural empyema after pneumonectomy due to nonsmall cell lung cancer 20 years previously. Insufficiency of the bronchial stump was ruled out by bronchoscopy and bronchography. Thoracic computed tomographic scan of the thorax detected an abscess located in the subcutaneous tissue of the right ventrolateral chest wall originating from severe pyogenic osteomyelitis of the fifth and sixth ribs. Our surgical management included partial resection of the chest wall followed by insertion of the vacuum-assisted closure system into the thoracic cavity. The patient fully recovered and was discharged on postoperative day 32.

Vacuum-assisted closure for the treatment of complex breast wounds

Complex breast wounds are a constant problem for surgeons. Wound vacuum-assisted closure therapy (VAC) has been shown to be effective for a variety of complex wounds. Our goal was to evaluate our experience with the (VAC) device in the treatment of open breast wounds. We retrospectively identified 18 patients with complex breast wounds treated with the VAC. We analyzed the data regarding the nature and management of these wounds using the VAC device. Fifteen of 18 patients were treated effectively using the VAC. Two patients required muscle flap coverage. One patient had the VAC dressing discontinued secondary to a denial by an insurance company for VAC in the home setting. VAC therapy is an effective treatment for complex wounds. Specifically, our experience shows it to be effective in the treatment of complex breast wounds. Utilization of VAC therapy should be considered for the management of these challenging wounds.

The management of complex soft-tissue defects after spinal instrumentation

Wound dehiscence after spinal instrumentation presents a challenging problem to the surgeon.[1][1]–[8][2] Soft-tissue complications after operation are most commonly seen in patients with poor nutritional status, in the presence of injury to the spinal cord, following multiple operations and in

Vacuum-assisted closure: microdeformations of wounds and cell proliferation.

The mechanism of action of the Vacuum Assisted Closure Therapy (VAC; KCI, San Antonio, Texas), a recent novel innovation in the care of wounds, remains unknown. In vitro studies have revealed that cells allowed to stretch tend to divide and proliferate in the presence of soluble mitogens, whereas retracted cells remain quiescent. The authors hypothesize that application of micromechanical forces to wounds in vivo can promote wound healing through this cell shape-dependent, mechanical control mechanism. The authors created a computer model (finite element) of a wound and simulated VAC application. Finite element modeling is commonly used to engineer complex systems by breaking them down into simple discrete elements. In this model, the authors altered the pressure, pore diameter, and pore volume fraction to study the effects of vacuum-induced material deformations. The authors compared the morphology of deformation of this wound model with histologic sections of wounds treated with the VAC. The finite element model showed that most elements stretched by VAC application experienced deformations of 5 to 20 percent strain, which are similar to in vitro strain levels shown to promote cellular proliferation. Importantly, the deformation predicted by the model also was similar in morphology to the surface undulations observed in histologic cross-sections of the wounds. The authors hypothesize that this tissue deformation stretches individual cells, thereby promoting proliferation in the wound microenvironment. The application of micromechanical forces may be a useful method with which to stimulate wound healing through promotion of cell division, angiogenesis, and local elaboration of growth factors. Finite element modeling of the VAC device is consistent with this mechanism of action.

Vacuum-assisted closure device system (VAC) in complex head and neck wounds

Objectives: Chronic complicated wounds represent a major health burden and a drain on resources. In the head and neck, they can also be cosmetically and functionally disabling. Over the past decade the vacuum-assisted closure device system (VAC) has become increasingly useful in the treatment of complex and nonhealing wounds of the trunk and extremities. However, the VAC system has not been previously reported in the treatment of head and neck wounds. Methods: A retrospective case series of patients is reviewed. The VAC device was incorporated in the management of 3 different patients with complicated head and neck wounds. The treatment guidelines and results are discussed. Results: All patients had either a large and/or infected wounds. There was a significant decrease in wound size after application of the VAC. This led to simplification of the surgical closure as well as a decrease in local morbidity. The requirement for skilled nursing wound care was also decreased. Favorable cosmetic results were established in all cases. Conclusion: The VAC device is a useful and effective tool in the management of patients with complex head and neck wounds. Its use in selected patients can decrease morbidity and improve functional and cosmetic results. Expanded applications should be further evaluated.