Vacuum-assisted Closure Device Research Articles

Use of a Vacuum-Assisted Closure Device in the Treatment of Recurrent Pagetʼs Disease of the Vulva

BACKGROUND Paget's disease of the vulva is a rare malignancy for which common recurrence is related to inadequate surgical margins. Excision with adequate surgical margins might leave a large defect that does not readily heal. CASE A 41-year-old woman with recurrent Paget's disease of the vulva underwent a skinning excision of the vulva and perineum. A vacuum-assisted closure device was placed on the wound until final pathologic analysis confirmed the adequacy of surgical margins. CONCLUSION The vacuum-assisted closure device not only allowed us to safely temporize wound closure until the final histopathologic results, but also helped secure the skin graft to the large and irregular surface. Additional studies are needed to determine the effectiveness of vacuum-assisted closure device therapy in Paget's disease of the vulva.

Use of a vacuum-assisted closure device in the treatment of recurrent Paget's disease of the vulva

Paget's disease of the vulva is a rare malignancy for which common recurrence is related to inadequate surgical margins. Excision with adequate surgical margins might leave a large defect that does not readily heal. A 41-year-old woman with recurrent Paget's disease of the vulva underwent a skinning excision of the vulva and perineum. A vacuum-assisted closure device was placed on the wound until final pathologic analysis confirmed the adequacy of surgical margins. The vacuum-assisted closure device not only allowed us to safely temporize wound closure until the final histopathologic results, but also helped secure the skin graft to the large and irregular surface. Additional studies are needed to determine the effectiveness of vacuum-assisted closure device therapy in Paget's disease of the vulva.

Vacuum-assisted wound closure (VAC therapy) for the management of patients with high-energy soft tissue injuries.

To evaluate the results of a vacuum-assisted closure device in patients presenting with open high-energy soft tissue injuries. Consecutive nonrandomized clinical study. From August 1999 through October 2000, 21 patients, with 21 high-energy soft tissue wounds (6 tibial, 10 ankle, and 5 with wounds of the forearm, elbow, femur, pelvis, and a below-knee stump) were treated with a vacuum-assisted closure device at a Level 1 trauma center. A negative atmospheric pressure device used for the management of complex open injuries. Infected wounds had dressings changed every 48 hours, whereas all others had dressings changed every 72 to 96 hours. The duration of vacuum-assisted closure use, final wound closure outcome, costs versus standard dressing changes or free flaps, and a list of all complications were recorded. All patients were followed for 6 months postcoverage. Patients averaged 4.1 sponge changes, 77% performed at bedside, with the device used an average of 19.3 days. Twelve wounds (57%) required either no further treatment or a split-thickness skin graft, and 9 (43%) required a free tissue transfer. The vacuum-assisted closure appears to be a viable adjunct for the treatment of open high-energy injuries. Application can be performed as a bedside procedure but additional soft tissue reconstruction may be needed for definitive coverage. This device does not replace the need for formal debridement of necrotic tissue, but it may avoid the need for a free tissue transfer in some patients with large traumatic wounds.

A Prospective Randomized Evaluation of Negative-pressure Wound Dressings for Diabetic Foot Wounds

Optimal treatment for large diabetic foot wounds is ill defined. The purpose of this study was to compare the rate of wound healing with the Vacuum Assisted Closure device trade mark (VAC) to conventional moist dressings in the treatment of large diabetic foot wounds. Diabetics with significant soft tissue defects of the foot were considered for enrollment. Patients were randomized to receive either moist gauze dressings or VAC treatments for 2 weeks, after which they were treated with the alternative dressing for an additional 2 weeks. Wounds were photographed weekly and wound dimensions calculated in a blinded fashion with spatial analysis software. Percent change in wound dimensions were calculated and compared for each weekly assessment and over 2 weeks of therapy with each dressing type. Ten patients were enrolled in the trial, but two were lost to follow-up and two were withdrawn. Complete data were available for analysis on seven wounds in six patients. Average length, width, and depth of the wounds at initiation of the trial was 7.7, 3.5, and 3.1 cm, respectively. Only the wound depth was significantly decreased over the weeks of the trial to 1.2 cm ( p < 0.05). VAC dressings decreased the wound volume and depth significantly more than moist gauze dressings (59% vs. 0% and 49% vs. 8%, respectively). VAC dressings were associated with a decrease in all wound dimensions while wound length and width increased with moist dressings. In summary, over the first several weeks of therapy, VAC dressings decreased wound depth and volume more effectively than moist gauze dressings. Negative-pressure wound treatment may accelerate closure of large foot wounds in the diabetic patient.

Vacuum-assisted complex wound closure with elastic vessel loop augmentation: a novel technique.

Patients with serious abdominal or soft-tissue injuries may require multistaged surgical management. The Vacuum-Assisted Closure device, used in combination with a shoelace technique, can promote fascial and soft-tissue approximation.

Case review: management of life-threatening sepsis and wound healing in a Klippel-Trenaunay patient using serial surgical d�bridements and vacuum-assisted closure

In Klippel-Trenaunay syndrome surgery is reserved for conditions which result in hemodynamic instability and sepsis. We report a pediatric patient with Klippel-Trenaunay syndrome and life-threatening wound sepsis responding to serial surgical debridements and application of the Vacuum-Assisted Closure device. The device was found to be an effective adjunct to the treatment algorithm.

Experience with the vacuum assisted closure negative pressure technique in the treatment of non-healing diabetic and dysvascular wounds.

The purpose of this study is to report our experience with the Vacuum Assisted Closure (VAC) negative pressure technique in patients with non-healing wounds of the foot, ankle, and lower limb. We retrospectively reviewed 17 patients with non-healing wounds of the lower extremity who underwent treatment using the Vacuum Assisted Closure (VAC) device. Thirteen of 17 (76%) had diabetes mellitus, nine of whom were insulin-dependent, and 10 of whom had associated peripheral neuropathy. Eight of 17 (47%) had severe peripheral vascular disease. All had failed previous management with serial wound debridements and dressing changes; 15 of 17 (88%) had previously completed at least one course of oral antibiotics. Thirteen of 17 (76%) had previously undergone operative irrigation and debridement of the wounds; six of 17 (35%) had previously undergone revascularization procedures of the involved extremity. Five of 17 (29%) had wounds necessitating an amputation procedure prior to the present treatment; seven of 17 (41%) had failed treatment with local growth factors prior to the present treatment. Average length of treatment with the VAC device was 8.2 weeks. Fourteen of 17 (82%) wounds successfully healed; four underwent split-thickness skin grafting for wound closure; four were briefly treated with local growth factors; six were treated with only dressing changes following VAC treatment. Three of 17 (18%) wounds failed VAC treatment; all three patients had diabetes and had wounds located in the midfoot or forefoot; two of three had severe peripheral vascular disease. Our results indicate that the Vacuum Assisted Closure negative pressure technique is emerging as an acceptable option for wound care of the lower extremity. Not all patients are candidates for such treatment; those patients with severe peripheral vascular disease or smaller forefoot wounds may be best treated by other modalities. Larger wounds seem to be better suited for skin grafting or two-stage primary closure.

The vacuum assisted closure device: a method of securing skin grafts and improving graft survival.

Use of the vacuum assisted closure device (VAC) for securing split-thickness skin grafts (STSGs) is associated with improved wound outcomes compared with bolster dressings. Consecutive case series. Consecutive patients at a level I trauma center requiring STSG due to traumatic or thermal tissue loss during an 18-month period. Repeated skin grafting due to failure of the initial graft. Secondary outcome measures included dressing-associated complications, percentage of graft take, and length of hospital stay. Sixty-one patients underwent STSG placement. Indications for STSG were burn injury (n = 32), soft tissue loss (n = 27), and fasciotomy-site coverage (n = 2). Patients were treated with the VAC (n = 34) or the bolster dressing (n = 27). The VAC group required significantly fewer repeated STSGs (1 [3%] vs 5 [19%]; P =.04). Two additional graft failures occurred in the no-VAC group, but repeated STSGs were refused by these patients. No difference was seen between the groups in age, percentage of graft take, or hospital length of stay. The no-VAC group had significantly larger grafts (mean +/- SD, 984 +/- 996 vs 386 +/- 573 cm(2); P =.006). The patients requiring repeated STSGs (n = 6) did not have significantly larger grafts than those not requiring repeated STSGs (mean +/- SD, 617 +/- 717 vs 658 +/- 857 cm(2); P =.62). No dressing-associated complications occurred in the VAC group. The VAC provides a safe and effective method for securing STSGs and is associated with improved graft survival as measured by a reduction in number of repeated STSGs.

Toxic Shock Syndrome Associated With the Use of the Vacuum-Assisted Closure Device

The vacuum-assisted wound closure technique and device (the V.A.C.) has become a widely accepted technique in the management of chronic and difficult wounds. The authors present the first reported case of toxic shock syndrome associated with its use. This article does not question the efficacy of the V.A.C. technique in the treatment of difficult wounds, but focuses on raising the index of suspicion of toxic shock syndrome in patients with wounds managed with the V.A.C. who develop early signs or symptoms that may be consistent with the diagnosis.

Vacuum-assisted closure in the treatment of a 9-year-old child with severe and multiple dog bite injuries of the thorax

The vacuum-assisted closure (VAC; KCI International, San Antonio, TX) device is a negative pressure dressing, which we have used in the treatment of wounds with devitalized or infected tissues. Although introduced in plastic and reconstructive surgery, its use has extended to orthopedic and cardiothoracic surgical practice in the treatment of infected joint replacement and sternal wound infections, respectively. Although the VAC is becoming more widely used in surgical practice, only a small number of case reports exist in addition to the original case series by Argenta and Morykwas in 1997. Previously, the device was described in treating single wounds in adult patients. We report a case where it was successfully used to treat multiple dog bite injuries in a 9-year-old child.

Vaccum assisted closure: an alternative strategy in the management of degloving injuries of the foot

A case of a degloving injury to the foot is presented in a patient who also sustained severe contralateral lower-limb trauma. We report a technique for salvaging the foot by replacing the degloved skin as a full-thickness graft and securing it using the vacuum-assisted closure (VAC™) device. A good outcome was achieved and technical tips are provided to facilitate reproduction of the procedure.

The vacuum-assisted closure device as a bridge to sternal wound closure.

Sixteen patients were treated for sternal wound infections after undergoing cardiac procedures. Their management involved prompt surgical debridement and quantitative wound biopsies. At the time of the initial debridement, the Vacuum-Assisted Closure Device (V.A.C.) was placed in the open sternal wound. A subatmospheric environment was maintained by the device at a level of 75 to 150 mmHg. The V.A.C. sponge was changed every 2 to 3 days, and operative debridement was performed until quantitative biopsies showed resolution of infection or until systemic signs of sepsis had resolved. At this time the sternal wounds were closed with regional muscle flaps. Patients were excluded from the use of the device if the pleural cavity was entered during operative debridement. Fifteen of the 16 patients survived and went on to complete wound healing and discharge from the hospital (average length of stay, 16.7 days). One patient sustained a cardiac dysrhythmia during the muscle flap procedure and died. There were no complications related directly to the use of the V.A.C. It is the opinion of the authors that the V.A.C. offers several advantages over their traditional methods of treatment. They noted improvement in sternal wound stabilization during the perioperative period and a decreased need for paralysis and mechanical ventilation. Wound management was improved by avoiding the need to perform debridement or to make desiccating dressing changes to an open sternum. Moreover, they also think that this device may lessen the risk for ventricular rupture because of better control of the wound environment and markedly improved stabilization of the debrided sternal elements.

Vacuum-Assisted Closure for Cutaneous Gastrointestinal Fistula Management

Background. Cutaneous gastrointestinal (GI) fistulas are a challenging complication in the oncologic patient population. The fistulous effluent is difficult to manage and adversely alters quality of life. Nonsurgical management of enteric fistulas is successful in 30% of cases, requiring at least 4 to 6 weeks. Recently a new technology has been developed to expedite wound healing. The Vacuum-Assisted Closure (VAC) method is a subatmospheric pressure technique that has been demonstrated in laboratory and clinical studies to significantly improve wound healing. Here we report its use in the successful medical management of a cutaneous GI fistula.Case. A 63-year-old woman with advanced ovarian cancer developed an extensive complex cutaneous GI fistula in an open healing wound. She was treated with total parental nutrition and the VAC device, which resulted in complete closure of the fistula.Conclusion. We propose that the VAC device may be a useful adjunct for the medical management of cutaneous GI fistulas.

Vacuum-Assisted Closure Device on Grafted Burn Wounds

Vacuum-Assisted Closure Device on Grafted Burn Wounds

The Evaluation of Subatmospheric Pressure and Hyperbaric Oxygen in Ischemic Full-Thickness Wound Healing

We evaluated the efficacy of subatmospheric pressure and hyperbaric oxygen (HBO) as adjuncts in the treatment of hypoxic full-thickness wounds in a rabbit model. We hypothesized that subatmospheric pressure and HBO independently are effective in improving wound healing in the ischemic wound model and that when they are used in combination there is an increased positive effect on wound healing. Using a standard ischemic wound model four full-thickness wounds were created on each ear of 41 male New Zealand white rabbits (N = 82 ears). On each rabbit one ear was dressed with the vacuum-assisted closure (VAC) device and connected to suction; the other was dressed identically without the suction and suction tubing. Twenty rabbits were treated with HBO daily for 10 days at 2.0 atmospheres absolute for 90 minutes plus descent and ascent times. Necropsy on all rabbits was performed on postoperative day 10. Four ischemic wound treatment groups were evaluated: Group 1 (N = 21) VAC dressing alone; Group 2 (N = 20) VAC dressing plus HBO; Group 3 (N = 21) VAC dressing to suction alone; and Group 4 (N = 20) VAC dressing to suction and HBO. Using light microscopy a veterinary pathologist blinded to treatment groups quantified peak granulation tissue, granulation tissue gap, and epithelialization tissue gap. Data were analyzed by analysis of variance with significance indicated by P < 0.05. Statistical significance was found in a comparison of VAC dressing to suction and VAC dressing alone for peak granulation tissue and granulation tissue gap both with and without use of HBO. VAC device use appears to increase the rate of healing in a rabbit ischemic wound model. HBO therapy did not significantly affect the rate of healing in this model.

Vacuum-assisted closure for the treatment of degloving injuries.

Degloving injuries of the hand and foot pose difficult reconstructive and rehabilitation challenges. After an excellent experience with split-thickness skin grafting with the vacuum-assisted closure device, we began studies with full-thickness skin grafts and traumatized skin. The device has been used with successful reapplication of full-thickness degloved skin in two patients. The first patient suffered degloving of the foot; the second patient, degloving of the hand.

Techniques for applying subatmospheric pressure dressing to wounds in difficult regions of anatomy

Subatmospheric pressure dressing (SPD) has been commercially available in the United States since 1995 as the vacuum-assisted closure (VAC) device. SPD increases local blood flow, decreases edema and bacterial count, and promotes the formation of granulation tissue. Despite recent clinical successes with the use of SPD in a variety of wound types, problems may occur with application of VAC system in certain areas of the body. The main limitation occurs when attempting to maintain an airtight seal over irregular surfaces surrounding a wound. For example, application of the adhesive drape and creation of a seal are particularly difficulty in the hip and perineum. In addition, wounds of the lower extremity can occur in multiple sites, posing the problem of providing a vacuum dressing to more than one wound from one suction pump machine. To address these challenging clinical wounds, we have developed techniques to allow the successful application of SPD to sacral pressure ulcers near the anus, and to multiple large lower extremity ulcers.