Vacuum-assisted Closure Dressings Research Articles

Role of Prophylactic Negative Pressure Dressings in Determining the Surgical Site Infection (SSI) on Closed Laparotomy Wounds in Abdominal Surgery: Randomized Controlled Open Label Trial: Vacuum Assisted Closure (VAC) Trial in a Tertiary Care Setup

Background: Surgical site infections (SSIs) continue to pose a significant challenge in postoperative care, particularly in abdominal surgeries, due to their prevalence and the associated increase in morbidity, mortality, and healthcare costs. Despite advancements in surgical techniques and aseptic measures, the incidence of SSIs remains high, underscoring the need for innovative preventive strategies. Objective: This study aims to evaluate the efficacy of vacuum-assisted closure (VAC) dressings compared to standard dressing methods in reducing the incidence of surgical site infections in patients undergoing closed laparotomy wounds in abdominal surgeries. Methods: A randomized controlled trial was conducted over six months at Civil Hospital Karachi, involving 116 patients undergoing abdominal surgeries. Participants were randomly assigned to receive either the VAC dressing or standard dressing postoperatively. The primary outcome measured was the incidence of SSIs within 30 days post-surgery, evaluated using the CDC classification and Southampton wound grading system. Data were analyzed using SPSS version 25.0, employing descriptive statistics, independent t-tests, and Chi-square tests for continuous and categorical variables, respectively. Results: The VAC group demonstrated a significantly lower incidence of SSIs (13.8%) compared to the non-VAC group (96.6%), with statistical significance (p < 0.001). Age and BMI showed significant differences between the groups; patients in the VAC group were younger (mean age 30.84 ± 10.71 years) and had a lower BMI (mean 19.69 ± 4.16 kg/m²) compared to the non-VAC group (mean age 37.31 ± 12.83 years, mean BMI 22.07 ± 4.41 kg/m²). The duration of surgery and length of incision did not significantly differ between the groups. Conclusion: The use of vacuum-assisted closure dressings significantly reduces the incidence of surgical site infections in abdominal surgery patients, offering a superior alternative to standard dressings. This method not only enhances patient outcomes but could also lead to a reduction in healthcare costs by minimizing complications associated with SSIs.

Functional Outcomes in Orthopaedic Open Wounds Treated With Vacuum-Assisted Closure Therapy: A Prospective Case Series.

Open fractures with extensive soft-tissue damage, significant periosteal stripping, and exposed bone ends pose a significant challenge in orthopaedics. So, we conducted a prospective study that investigated the efficacy of vacuum-assisted closure (VAC) therapy in improving functional outcomes for orthopaedic open wounds. A prospective case series was conducted for a period of 18 months at the department of orthopaedics. Seventeen patients with open wounds were included in the study after fulfilling specific criteria. The study involved 17 patients with open wounds, where VAC therapy was applied within 24 hours of admission for 14 patients, and for three patients with superficial infection, thorough wound debridement preceded VAC dressing. Follow-up with patients continued until definitive skin cover procedures were performed. The majority of cases were attributed to open compound fractures caused by road traffic accidents (82.35%), followed by train traffic accidents (11.76%) and accidental falls (5.88%). The leg (47%) was the most common location of injury, followed by the forearm (23.52%). The average treatment duration was 10.5 days, with an average of 3.3 dressing changes, indicating the efficacy and feasibility of VAC therapy in clinical practice. The average wound size reduction at completion was 15mm, and 15 out of 17 patients achieved successful wound healing. The average time required for forming a uniform granulation bed was 10.5 days, highlighting the efficiency of VAC therapy in promoting tissue regeneration. Our study findings revealed that there is a significant reduction in the rate of wound infection with the application of VAC therapy, along with a shorter duration for the formation of healthy granulation tissue, rendering the wound suitable for definitive skin cover procedures such as split skin graft and flap cover at an accelerated rate. Additionally, technical challenges associated with applying VAC dressing in the presence of an external fixator were successfully managed through realignment strategies, further underscoring the adaptability and efficacy of VAC therapy in addressing complex wound scenarios.

Efficacy of combining a medial superior malleolar perforator flap from the posterior tibial artery with a vacuum-assisted closure dressing for skin and soft tissue defects of the Achilles tendon area.

This randomized clinical trial aimed to investigate the clinical efficacy of combining a medial superior malleolar perforator flap from the posterior tibial artery (PTAPF) with a vacuum-assisted closure (VAC) dressing for skin and soft tissue defects in the Achilles tendon area. Twenty-eight patients were randomly divided into two equally sized groups: the control group received treatment with a medial superior malleolar perforator flap, while the experimental group was treated with a perforator flap from the posterior tibial artery in combination with a VAC dressing. Perioperative data, including average operative time, intraoperative blood loss, intraoperative complications, time to ambulation, and hospital stay after surgery, were recorded. Clinical outcomes were assessed based on the time to first weight-bearing walking, time to full weight-bearing activity, Visual Analog Scale (VAS) score, American Orthopaedic Foot and Ankle Society hindfoot and ankle score, and the range of motion for ankle plantar flexion. The patients were monitored for 3-12 months (average, 8.5), and it was observed that the flaps remained stable without enlargement, and their texture and color were similar to the surrounding tissue. Significantly enhanced postoperative indices were noted in the experimental group compared to the control group (P<0.05). The medial superior malleolar perforator flap from the posterior tibial artery, especially when combined with a VAC dressing, proves to be an effective method for repairing medium-sized skin defects in the Achilles tendon area. This approach offers several benefits, including a reliable blood supply, simplicity of the procedure, decreased damage to the donor site, improved aesthetic outcomes, and fewer postoperative complications.

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.

Use of vacuum-assisted closure in the treatment of complex intrapleural infections

Background: Debilitated patients with chronic empyema, who are not fit enough to undergo thoracotomy and decortication due to lung entrapment, may be offered a lower-risk alternative – an open-window thoracostomy. Vacuum-assisted closure (VAC) may accelerate empyema drainage and wound closure.&#x0D; Methods: In this study, we compared two cohorts of patients receiving open-window thoracostomy (OWT) with or without VAC dressing. We included patients with chronic or postresectional empyema with multiple comorbidities or in poor general condition or on immunosuppression.&#x0D; Results: Delayed wound closure by thoracoplasty was performed in 8 (28%) patients in the OWT group and 8 (53%) patients in the OWT-VAC group (OR 2.54; 95% CI: 0.704-9.168). Time until DWC was significantly shorter (p&lt;0.001) in the OWT-VAC group (48.5 ± 27.5 days) compared to the OWT group (316.5 ± 102.5 days). Regarding complications, we found no significant differences between the two groups, except for air leak, which was found in 0 (0%) patients in the OWT group and 6 (40%) patients in the OWT-VAC group (OR 1.67; 95% CI: 1.10-2.52; p&lt;0.001). The percentage of patients who required re-do surgery did not differ significantly between the groups - 1 (3%) patient in the OWT group vs. 2 (13%) patients in the OWT-VAC group (OR 7.0; 95% CI: 0.66 – 74.29; p=0.07).&#x0D; Conclusion: Our experience shows that using VAC therapy in OWT can significantly shorten the overall treatment time. It can be safely used at home and in an outpatient setting.

Vacuum assisted closure for defects of the abdominal wall after intestinal transplantation

BackgroundIsolated intestinal transplantation (IT) is indicated in cases of intestinal failure (IF) in the absence of severe liver dysfunction. Short bowel syndrome (SBS) is the most frequent IF etiology, and due to the absence or considerable reduction of intestinal loops in the abdominal cavity in these patients, there is atrophy and muscle retraction of the abdominal wall, leading to loss of the abdominal domain and elasticity and preventing the primary closure of the abdominal wall. This study aimed to describe a technique for the closure of the abdominal wall after IT without using prostheses.MethodsFour patients underwent IT with the impossibility of primary closure of the abdominal wall. We describe a novel technique, associating a series of vacuum-assisted closure dressings, components separation, and relaxation incisions.ResultsAll patients presented a successful closure of the abdominal wall with the described technique, with no complications related to the abdominal wall.ConclusionThe technique proved to be safe, effective, and reproducible as an option for abdominal wall closure after IT. Employing this technique in a greater number of cases is necessary to confirm these results.

Experience of Vacuum-Assisted Closure in the Surgical Treatment of Malignant Skin Tumors after Skin Grafting

BACKGROUND: Skin grafts may be used to reconstruct large skin defects after the excision of malignant skin tumors. Vacuum-assisted closure (VAC) leads closer approximation of the free flap. AIM: The objective of this study was to estimate the engraftment of grafts using VAC and explore factors influencing this process. MATERIALS AND METHODS: This study included 31 patients with skin cancers after a wide tumor excision. The wound defects were closed using a split-thickness skin graft and the VAC dressing. RESULTS: Complete and partial engraftment was observed in 17 (54.8 %) and 14 (45.2%) cases, respectively. The mean area of the wound defects among patients with complete engraftment was 24.3 ± 20.6 cm2, while that of the group with partial engraftments was 56.5 ± 58.8 cm2 (p = 0.0017). In the complete engraftment group, the average number of days with the VAC dressing was 7.2 ± 0.44 days, versus 6.9 ± 0.27 days in the partial engraftment group (p = 0.032). CONCLUSION: VAC dressing after skin grafting in the surgical management of malignant skin tumors provided good results. The area of the wound defect and the average number of days with VAC dressing is significant factors influencing the outcomes of skin grafting.

Incisional Wound Vacuum-Evaluation of Wound Outcomes in Comparison With Standard Dressings for Posterior Spinal Fusions in Traumatic Patients.

Postoperative incisional negative pressure wound vacuum-assisted closure (VAC) dressings are being used as a primary dressing to optimize wound healing and help avoid complications of infection and dehiscence. Few studies have investigated whether application of VAC dressings on postoperative posterior spinal wounds can reduce the incidence of surgical site infections. To describe our single-surgeon experience of using primary VAC after posterior spinal fusion (PSF) in a large sample of trauma patients. This was an Institutional Review Board-approved retrospective comparative study and included all trauma patients presenting to our level 1 safety-net trauma center who required PSF and were operated on by the senior surgeon between 2016 and 2021. Primary outcomes were complications (surgical site infection, readmission for infection, and wound-related return to operating room [OR]) within 90 days after surgery. χ2 testing and Student t testing were used to assess differences between treatment groups while bivariate and multivariate regression was performed for outcome assessment. Two hundred sixty-four patients met criteria and were included. One hundred fifty-seven (59%) were treated with standard dressing and 107 (41%) with VAC. Patients treated with VAC were more likely to be older (P = .015), have diabetes (P = .041), have an elevated body mass index (P = .020), and had more levels of fusion (P = .002). Despite this, presence of VAC was independently associated with decreased 90-day infection (hazard ratio = 0.397, P = .023) and decreased 90-day return to OR for wound-related reasons (hazard ratio = 0.099, P = .031). Compared with the use of standard dressing, VAC was found to decrease surgical site infection and return to OR risk in trauma patients undergoing PSF.

Repair of pseudoaneurysm in extra-anatomic aortic arch bypass graft.

Repair of pseudoaneurysm in extra-anatomic aortic arch bypass graft.

Gastric perforation leading to the diagnosis of classic Ehlers\u2013Danlos syndrome: a case report

BackgroundEhlers–Danlos syndrome is a clinically and genetically heterogeneous group of heritable connective tissue disorders caused by a defect in collagen synthesis and structure. The vascular subtype (Ehlers–Danlos syndrome IV) is reported to be associated with a higher incidence of gastrointestinal perforations. The most reported site of perforation is the colon, followed by the small bowel. Perforation of the stomach is very rare, and there are no reported cases to date of classic types I and II.Case presentationWe present the case of a 14-year-old Saudi girl who visited our emergency department with abdominal pain and vomiting. Initially, she was diagnosed with gastroenteritis and discharged once her condition stabilized. After 48 hours, she developed severe abdominal pain with recurrent vomiting and peritonitis evident on clinical examination. Initial abdominal x-ray failed to show any free air; however, enhanced computed tomography revealed free air and contrast extravasation in the proximal gut. During exploratory laparotomy, a large perforation was found on the anterior wall of the stomach due to the underlying ischemia. The posterior wall had ischemic mucosa with an intact healthy serosa. A free-hand partial gastrectomy was performed to resect all ischemic parts of the stomach. Detailed examinations and laboratory workup were carried out after the surgery to figure out the possible underlying cause. The clinical findings during the physical examination supported marfanoid features. Marfan’s syndrome and related disorders sequencing panel was requested, and Deoxyribonucleic acid (DNA) samples were sent. Given results were supporting the diagnosis of classical Ehlers–Danlos syndrome, the patient was labeled as a case of Ehlers–Danlos syndrome. During the postoperative period, she developed a wound infection that was managed successfully with vacuum-assisted closure dressing. She recovered well without gastrointestinal sequelae in the 4 years of follow-up.ConclusionsHeritable systemic connective tissue diseases must be given serious consideration in young patients with unusual spontaneous perforation. Such patients might develop life-threatening conditions that require immediate intervention. Hence, correct and timely diagnosis is important to prepare for the anticipated complications.

Comparison of the mean healing time of wound after vacuum assisted closure versus conventional dressing in diabetic foot ulcer patients

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Diabetic foot ulcers (DFU’s) are chronic wounds in diabetics resulting from ischemia, angiogenesis defects and impaired immunity. Vacuum assisted closure (VAC) provides a new paradigm for diabetic wound dressing. This study compares the mean healing time of wound after VAC versus conventional dressing (CD) in DFU patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: This randomized controlled trial carried out at surgery department, at tertiary teaching hospital over a period from 28&lt;sup&gt;th&lt;/sup&gt; February-27&lt;sup&gt;th&lt;/sup&gt; August 2020. Total 60 patients of age (25-75 years), both genders having DFU were included. Patients were placed randomly into two groups i.e., group A (VAC therapy) and group B (CD), by using lottery method. Mean healing time noted in both groups. For statistical analysis, SPSS version 20.0 was used. Independent ‘t’ test used to compare the mean healing time of both groups and p≤0.05 considered significant. Effect modifiers were controlled through stratification and post-stratification independent ‘t’ test, to see their effect on healing time. P≤0.05 was considered significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: The mean age of patients in group A was 53.13±9.09 years and in group B was 53.53±9.09 years. Out of 60 patients 41 (68.33%) were males and 19 (31.67%) were females. The mean healing time of wound in DFU patients after VAC closure (group A) was 12.07±2.15 days and after CD (group B) was 17.50±3.16 days with p=0.0001.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions&lt;/strong&gt;: Study concluded that mean healing time after VAC is less in DFU patients as compared to CD.&lt;/p&gt;

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.

Wound management using homemade vacuum dressing, affordable and customized (homemade vac)

Introduction: The vacuum-assisted closure (VAC) has proved to be very promising in the management of difficult to heal wounds. However, the first reports about the use of negative pressure wound device came from Argenta and Morykwas in the year 1997. Though there are various commercially prepared and manufactured vacuum assisted closure dressing materials, these are often unavailable or unaffordable to patients in third world countries. Our “homemade” vacuum dressing has been found to be, affordable for our patients and most importantly effective in wound management. Materials and methods : The homemade Vacuum Assisted closure dressing was used for the management of some wounds which presented at our centre. These wounds were irrigated and thoroughly debrided. Our homemade vacuum assisted closure dressings were subsequently applied. Results: The wounds healed well with good granulation tissue. Subsequent split thickness skin graft (SSG) done had very good take. The VAC dressing often resulted in good wound contraction with no need for SSG. Conclusion: In our practice our “home made” vacuum which was affordable and customized proved to be effective in wound management.

OUTCOMES OF VAC VERSUS CONVENTIONAL DRESSING IN MANAGEMENT OF DIABETIC FOOT ULCER

Background: Foot wounds in people with diabetes mellitus (DM) are common and serious global health issue. Negative pressure wound therapy can be used to treat these wounds and a clear and current overview of current evidence is required to facilitate decision-making regarding its use. Objective: To assess the efficacy of vacuum assisted closure dressings as compared to conventional moist wound dressings in improving the healing process in diabetic foot wounds. Patients and methods: This prospective randomized comparative study was conducted in the General and Vascular Surgery Departments at Al-Azhar university hospitals and Al-Ahrar teaching hospital, in the period from January 2019 to May 2020. The study included 30 patients randomized into two equal groups: VAC therapy and conventional dressing suffering from diabetic foot wounds. All chronic wounds where conventional dressings indicated were included in the study. Results: Wound bed showed signs of healing by granulation tissue formation in 11 among 15 patients (73.3%) in VAC therapy group. In conventional treatment, 4 showed granulation among 15 patients (26.7%) one week after initiation of treatment. (P=0.01). There was a statistically significant difference between average granulation as % of ulcer area and it was significantly high in vacuum dressing. It was 50.2 ± 18.9 in Conventional treatment compared with 77.4 ± 19.3 in NPWT group (p- value = 0.005). Also, at the end of the study, we found that the total mean cost in conventional dressing group was 1993 ± 193 EP compared to 2261 ± 183 EP in VAC group. There was a difference in the total cost finally. Being higher in cost, VAC therapy although has a shorter hospital stay and faster healing time in comparison with conventional dressing. Conclusion: Negative pressure wound therapy (NPWT) using vacuum-assisted closure (VAC) was more efficacious than conventional therapy in the management of foot ulcers in diabetic patients. Hospital stay was significantly shorter in NPWT patients, so less consuming of hospital service than conventional dressing. This is finally decreasing the total budget to the hospital.

The use of negative pressure therapy for the treatment Of lower-extremity wounds.

Abstract Background: lower extremity wounds with exposed bone, tendon or orthopedic hardware present a difficult treatment challenge. Objective: The purpose of this study is to assess the role of the vacuum assisted closure (VAC) therapy in the management of lower extremity wounds. Material and methods: A prospective analytic cohort study was conducted among 15 patient referred for reconstruction of lower extremity wounds. The study was conducted between January 2019 to June 2019. The wounds were inspected, surgical debridement was done if needed, and the VAC dressings were changed every 72 hours. Primary outcome was wound healing and granulation tissue formation. Secondary outcome was wound infection and wound size. Results: Vacuum- assisted closure therapy greatly decrease the surface area of the wound. Profuse granulation tissue formed rapidly, covering the bone and hardware. There was no statistically significant difference between the included patients regarding the pattern of wound infection pre and after negative pressure therapy (p=0.655). Results were both functionally and aesthetically satisfactory. Conclusion: VAC therapy appears to be a simple and more effective than conventional dressings for the management of difficult wound in terms of reduction in wound volume, depth, treatment duration and cost minimize the number of local and free-flap transfers.

Practical Things You Should Know about Wound Healing and Vacuum-Assisted Closure Management.

After reading this article, the participant should be able to: 1. Understand the basics of negative-pressure wound therapy and practical uses of various vacuum-assisted closure dressings. 2. Understand the mechanisms of action of negative-pressure therapies and other important adjuncts, such as perfusion imaging. 3. Discuss the evidence for hyperbaric oxygen therapy in wound care. Wound healing requires creating an environment that supports the healing process while decreasing inflammation and infection. Negative-pressure wound therapy has changed the way physicians manage acute and chronic wounds for more than 20 years. It contracts wound edges, removes exudate, including inflammatory and infectious material, and promotes angiogenesis and granulation tissue formation. These effects have been consistently demonstrated in multiple animal and human randomized controlled trials. Recent innovations that include instillation therapy and closed incision have further increased our arsenal against difficult-to-treat wounds and incisions at high risk of complications. Instillation of topical wound solutions allows physicians to cleanse the wound without return to the operating room, resulting in fewer debridements, shorter hospital stays, and faster time to wound closure. Other concepts have yielded negative-pressure therapy on top of closed surgical incisions, which holds incision edges together, reduces edema, promotes angiogenesis, and creates a barrier to protect incisions during the critical healing period, thereby reducing surgical-site complications, especially infection. Other practical adjuncts to the modern-day treatment of acute and chronic wounds include indocyanine green angiography, which allows real-time assessment of perfusion, and hyperbaric oxygen treatment, which has been suggested to augment healing in acute, chronic, specifically diabetic foot ulcers and radiation-related wounds.

Vacuum-assisted closure versus moist dressings in the treatment of diabetic wound ulcers after partial foot amputation: A retrospective analysis in 65 patients.

Changes in weight-bearing patterns after partial foot amputations may lead to new localized high-pressure points and keratosis due to ulcerations in patients with neuropathies and hypovascular limbs. As a result, diabetic foot ulcers (DFUs) after partial foot amputations are very complex. The aim of this study was to compare the effectiveness of vacuum-assisted closure (VAC) therapy with conventional moist wound dressings in the treatment of diabetic wound ulcers after partial foot amputations. Sixty-five diabetic patients with a DFU, who had previously undergone partial foot amputation surgery, were assigned to treatment with VAC (group A: 31 patients) or conventional wound moist dressing (group B: 34 patients). The final results were considered as failed treatment if reamputation was required. Conversely, reaching 90% of wound granulation was considered to be a successful endpoint. The average time to reach 90% granulation tissue was significantly lower in group A (7.8 ± 1.2 weeks vs. 11.1 ± 1.2 weeks; p < 0.001). However, there was no significant difference regarding the reamputation requirements; 38.7% (12 patients) in group A and 41.2% (14 patients) in group B, ( p = 0.839). The results of this study allowed us to conclude that VAC therapy system appears to be an effective treatment for patients with complex DFUs who had previously undergone partial foot amputation.

Necrotizing fasciitis of the head and neck: our experience with vacuum-assisted closure therapy.

To present the outcomes of our case series of head and neck necrotizing fasciitis (HNNF) in which vacuum-assisted closure (VAC) is used in most of the cases in the treatment. Case series in a tertiary referral center. Eleven patients were treated for HNNF between January 2008 and January 2017. Patients were two females and nine males, the mean age was 57.1. Oral cavity and tracheotomy/tracheostomy sites were the main aetiological foci of the infection. Three patients were treated with aggressive debridements and conventional dressing, whereas eight patients were treated with incision and exploration followed by limited skin excisions and VAC dressing. The mean number of surgical debridements was 2.3. The mean length of hospital stay was 41.8days. Complications were observed in all patients except one. The mortality rate of HNNF in our series was 18%. The cause of death was severe sepsis and multi-organ failure in one case and mediastinitis followed by respiratory distress syndrome in the other case. HNNF is still a mortal disease and surgical debridements are crucial. The current study is the only case series in the literature in which VAC treatment was used in consecutive cases of HNNF. VAC treatment can play a major role in the post-operative care of HNNF patients. It reduces the amount of excised skin during debridements and stimulates wound healing. VAC treatment may be included in the treatment protocol of HNNF alongside surgical debridements and medical therapy.

The use of vacuum-assisted closure in spinal wound infections with or without exposed dura.

The treatment of postoperative deep spinal wound infection involves debridement and intravenous antibiotics. Authors have previously reported success in a small series of patients treated with vacuum-assisted closure (VAC) therapy, but its use over exposed dura is controversial and the outcome has not been reported in large series. To review the outcomes following the treatment of postoperative spinal infections with VAC therapy, particularly those with exposed dura. This is a review of prospectively collected data in 42 patients, all of whom had deep postoperative spinal infections. 30 of these patients had exposed dura. All patients had an initial debridement followed by application of VAC Whitefoam (with exposed dura) or grey Granufoam (where no dura was exposed). Pressure was set at 50mmHg with exposed dura or 125mmHg where no dura was exposed. All patients underwent a minimum 6week course of antibiotics. We report on the number of visits to theatre required for dressing changes and debridement and the eventual outcomes. Five patients required a flap reconstruction. Two patients died before definitive final closure due to other complications (pneumonia and stroke). In all the other patients, their wounds healed fully. A mean of 2.3 infection surgeries were required to eradicate infection and achieve wound closure. This is one of the largest studies which confirms the safety and efficacy of VAC dressings in patients with spinal wound infections, even when the dura is exposed. These slides can be retrieved under Electronic Supplementary Material.

Outcomes of VAC versus conventional dressings in patients with lower limb ulcer

Background: Chronic leg ulcers are a significant cause of morbidity in developing countries causing a significant burden on the health care system. The orthodox methods of dressing the wound requires long duration of hospital stay. The recent technique of vacuum assisted closure (VAC) has brought about new horizons in wound management with better outcomes.Methods: A comparative randomized case control study was conducted with a total of 60 patients from November 2015 to December 2017 in patients admitted with lower limb ulcers to KIMSDU, Karad, Maharashtra.Results: The mean graft uptake of Group A(VAC) and Group B (conventional dressings) was 82.23±15.60 and 70.07±18.42 respectively. Healing was achieved in minimum of 11 days and maximum of 48 days in Group A and minimum of 22 days and maximum of 59 days in Group B. The mean duration of wound healing in Group A and Group B was 27.70±9.57 and 41.93±11.58 days respectively. The duration of hospital stay was minimum of 13 days and maximum of 50 days in Group A and minimum of 24 days and maximum of 60 days in Group B.Conclusions: Rate of granulation tissue formation, overall graft survival and patient compliance was better in vacuum assisted closure dressing group as compared to conventional dressing group. It was also seen that the overall hospital stay and post-operative complications were less in the vacuum assisted closure dressing group.