Vacuum-assisted Closure Therapy Research Articles

Comparative study of vacuum-assisted closure therapy versus vacuum-assisted closure therapy supplemented with vitamin C in compound wound healing

Background: It is imperative for early and precise management of the compound wound for preventing further complication and delaying definitive management. As we all know superiority of vacuum assisted closure (VAC) therapy in wound management over any other method, but adding vitamin C has been shown to accelerate wound healing, reducing hospital stay, and cost of management and prevention of delaying definitive management of wound due to some conspicuous property of vitamin C that serve as superior adjuvant in wound healing. Methods: A case series of 40 patients who have been inflicted with compound wounds with most following road traffic accidents. We then categorised patients and tried to observe any difference in rate of satisfactorily healing of wound with 20 patients put on VAC therapy alone and other 20 patients put on VAC therapy supplemented with vit C. Results: Patients who were undergoing VAC dressing and supplemented with vitamin C, not only portrayed a better result of wound healing but also reduced the amount of vacuum dressing sittings. Conclusions: It was observed that, in general, patients who were undergoing VAC dressing and supplemented with vitamin C, not only portrayed a better result of wound healing but also reduced amount of vacuum dressing sittings, improved rate of granulation tissue, reduced hospital stay, early definitive fixation of associated fracture and skin grafting and showed superior outcomes in terms of better tissue recovery.

What Has Changed in the History of Fournier's Gangrene Treatment: The Single-Center Experience.

Fournier's gangrene (FG) is a rapidly progressive infection that requires emergent intervention. Wound closure is an important treatment step after surgery, and vacuum-assisted closure (VAC) can be preferred as an alternative method for wound closure. FG severity index (FGSI) scales that can be developed to evaluate the prognosis in FG. This study aims to compare VAC therapy, which was used and developed in the historical development of FG therapy, with conventional wound dressing (CWD). Data on who 85 patients treated at our hospital with a diagnosis of FG from January 2010 to July 2021. In the VAC group, the vacuum device was applied in a sealed manner. In the CWD group, mesh dressing was prepared. The VAC device was adjusted to subatmospheric pressure. Broad-spectrum antibiotics were administered to all patients during their follow-up. During the follow-up, as necrotic tissues were detected, redebridements were performed by providing appropriate analgesia and anesthesia. Demographic data of the patients were collected on the records. The clinical and laboratory data were obtained from the records at the 1st h, 72 h, and 1st week FSGI values were calculated. In statistical analysis, continuous variables were expressed as mean±standard deviation, ordinal variables were expressed as median [IQR], and categorical variables were expressed as n (%). In intergroup analyses, student's t-test was used if the data were normally distributed. If it did not show normal distribution, the Mann-Whitney U-test was applied. Fifty-five patients who were diagnosed with FG were included in our study. CWD was applied to 18 patients, and VAC was applied to 37 patients. The mean 1st h FGSI of the patients who used VAC was 7.05 (3.75-8), and the patients who had CWD were 5.5 (5-9) (p=0.067). Mean 72nd-h FGSI was found to be 5.35 (3.5-7) in the VAC group and 5.33 (4.75-6.25) in the CWD group (p=0.714). The mean 1st-week FGSI VAC group was 2.97 (1-5), and in the CWD group, it was 5 (4-6) (p=0.0001). VAC significantly reduces the length of hospital stay. In our analysis, both groups observed a significant difference between the 1st-week FGSIs. This is the first study to evaluate FGSI, which is an essential predictor of the effect of VAC therapy used in treating FG. In the history of FG treatment, CWD has been replaced by VAC.

Outcome of vacuum assisted dressing in open comminuted tibial fracture with primary fixation

Background/Aim: Wound management of the compound open tibia (Gustilo-Anderson grade 2, 3a, 3b) is complicated by a higher infection and the problem of adequate soft tissue coverage is significant. Primary wound closure is not easily advisable in these types of compound open tibial fractures. Early tissue flap or graft procedure might increase the complication rate due to temporary graft rejection and wound infections. The aim of this study was to analyse the duration required for formation of healthy granulation tissue, duration required for making wound fit for skin cover procedure and duration of hospital stay in compound open tibia fracture treated with vacuum assisted closure (VAC). Methods: A prospective interventional study of 22 patients aged 18 to 60 years was done. After assessing the size of the wound, primary bone fixation and wound debridement were carried out as soon as possible and then VAC was applied. Assessment of VAC therapy was based on mean decreases in wound size and "modified Johner and Wruh's criteria", used for assessment of the functional outcome of tibial shaft fracture was recorded during each follow-up. Results: Twenty two patients suffered comminuted open fractures of tibia-fibula. Primary fixation of bone were done with vacuum dressing. During follow-up, the good decrease in wound size considering vacuum dressing remedy was once 18.75 ± 18.36 cm2 (p = 0.001). Six patients achieved excellent results according to "modified Johner and Wruh's criteria" of tibial shaft fracture. Conclusion: This technique effectively reduced wound size, accelerated the formation of healthy granulation tissue of wound with open fracture bone and provided a better functional outcome. The VAC treatment had suggestively increased wound closure rate, decreased morbidity and costs for patients.

Carotid EndoVAC: a novel hybrid technique for carotid Dacron patch infection

This paper reports the use of the EndoVAC technique in a case of left carotid artery Dacron patch infection. The EndoVAC technique involves a sequence of endovascular relining with a stent graft, surgical debridement with explantation of infected graft material and secondary intention wound healing with a vacuum-assisted closure (VAC) device and long-term antibiotic treatment. Our patient was considered a high-risk surgical candidate due to previous cranial nerve injury, high carotid stent graft positioned in zone 3 of the neck, and high stroke risk due to aberrant cerebrovascular anatomy. The carotid EndoVAC technique was performed without complication and a successful outcome was observed at 1-year follow-up. Although currently not recommended as first-line management in treating vascular graft and endograft infections of the carotid vessels, the EndoVAC approach should be considered in a select cohort of patients when neither traditional radical surgery nor conservative simple VAC therapy are considered feasible or safe.

Abdominal Compartment Syndrome in Acute Pancreatitis: A Narrative Review.

Abdominal compartment syndrome (ACS) represents a severe complication of acute pancreatitis (AP), resulting from an acute and sustained increase in abdominal pressure >20 mmHg, in association with new organ dysfunction. The harmful effect of high intra-abdominal pressure on regional and global perfusion results in significant multiple organ failure and is associated with increased morbidity and mortality. There are several deleterious consequences of elevated intra-abdominal pressure on end-organ function, including respiratory, cardiovascular, gastrointestinal, neurologic, and renal effects. It is estimated that about 15% of patients with severe AP develop intra-abdominal hypertension or ACS, with a mortality rate around 50%. The treatment of abdominal compartment syndrome in acute pancreatitis begins with medical intervention and percutaneous drainage, where possible. Abdominal compartment syndrome unresponsive to conservatory treatment requires immediate surgical decompression, along with vacuum-assisted closure therapy techniques, followed by early abdominal fascia closure.

Management of a rare case of pediatric deep sternal wound infection with vacuum-assisted closure (VAC)

Background: Deep sternal wound infection (DSWI) or mediastinitis is a severe and life-threatening infection with high morbidity and mortality rates. Vacuum-assisted closure (VAC) provides good results and is very useful in wound closure. VAC therapy is a safe and affordable method for managing complex sternal and thoracic injuries. The use of VAC has been shown to increase parasternal blood flow by dilating arterioles, reducing bacterial load, and accelerating granulation tissue formation. It also helps with facilitating wound edge closure. Case and Operation Technique: A 6-month-old baby presented with an ulcer 2 cm deep in the thorax region. The wound had an exposed bone surrounded by slough and hyperemic edges. Bone destruction was seen to have reached the costochondral joint with a gross visible appearance of the pleura. Management of this patient included debridement, sternotomy, internal fixation of the sternum using the Robiscek technique, and application of the Water Shield Drainage (WSD) and VAC. The tobacco-sack technique was used to close the open wound. The Robiscek technique was used in this patient because of the bone destruction to the costochondral joints causing the sternum to become unstable. The VAC dressing was then connected to a suction with an intermittent negative pressure of 75mmHg. After a significant decrease in the wound surface area, a local rotational flap was used to close the wound. Conclusion: The use of modified VAC for deep sternal wound infection (DSWI) is effective, simple, and affordable with minimal complications.

Evaluation of the Impact of Vacuum-Assisted Closure Therapy in Post-Operative Patients with Entero-Cutaneous Fistulae

Evaluation of the Impact of Vacuum-Assisted Closure Therapy in Post-Operative Patients with Entero-Cutaneous Fistulae

Results of VAC (Vacuum Assisted Closure) therapy in the treatment of compound fractures of long bones

Results of VAC (Vacuum Assisted Closure) therapy in the treatment of compound fractures of long bones

Effect of vacuum assisted therapy in wound healing

Background: Vacuum assisted closure (VAC) is a new technique developed in the management of contaminated, acute, and chronic wounds. It refers to wound dressing system that continuously or intermittently apply sub-atmospheric pressure to the surface of a wound which accelerates debridement and promote healing. The optimum pressure for VAC is around 125 mmhg below ambient and this negative pressure helps in removing interstitial fluid, decreases localised edema and increases blood flow. This in turn decreases tissue bacterial levels and promotes wound healing.Methods: Hospital based prospective study.Results: Most common etiology for wounds is diabetes i.e., 50%, Most common organism cultured from wound is Staphylococcus aureus, and least is proteus. Surface area of wound is reduced to <40 cm2 in 76% cases and 7% cases had >60 cm2. After applying VAC dressing 91% of patients had bright red granulation tissue. Mean duration hospital stay was reduced to 10days in patients with VAC dressing.Conclusions: VAC or NPWT therapy is an excellent alternative modality of treatment of acute or chronic large non-healing wounds. It reduces the number of changes of dressing and reduces the time of hospital stay before definitive surgery for covering wound can be planned. Based on the data from the present study and other studies available, VAC appear to result in better and rapid healing and thus a better option of wound management technique.

Efficiency of the vacuum-assisted closure method in the treatment of chronic venous ulcers and the role of the nurse

Objectives: In our study, it was aimed to reveal the effects of using vacuum-assisted closure (VAC) systems in addition to compression therapy on wound healing in patients hospitalized for chronic venous ulcers. Patients and methods: Fifty-five patients (37 males, 18 females; mean age: 43±5 years, range, 38 to 48 years) who were hospitalized in our clinic for chronic venous ulcers between January 2015 - December 2021 were included in this retrospective study. The demographic data, wound widths, healing times of venous ulcers, length of hospital stay, and surgical treatment methods of patients who did (Group 1) and did not (Group 2) receive VAC therapy in addition to the surgical and medical procedures in the treatment of venous ulcers were compared. Results: The hospital stay of all patients was 9±2 days. While the mean ulcer healing time was 14±2 days in Group 1, it was 48±8 days in Group 2 (p=0.03). The mean hospital stay of the patients was 8±2 days in Group 1, whereas it was 15±3 days in Group 2 (p=0.04). Conclusion: As a result of the study, it was revealed that VAC therapy greatly increased the effectiveness of venous surgical methods and compression therapy in the treatment of chronic venous ulcers and shortened the treatment period; therefore, VAC therapy should be added to the treatment protocol for suitable patients with chronic venous ulcers.

S2493 Endoluminal Vacuum-Assisted Wound Closure Therapy for Anastomotic Leak Following Robotic-Assisted Colorectal Cancer Surgery

S2493 Endoluminal Vacuum-Assisted Wound Closure Therapy for Anastomotic Leak Following Robotic-Assisted Colorectal Cancer Surgery

The Combination of Vacuum Assisted Closure Therapy and Platelet Rich Plasma for Management of Diabetic Foot Wound

The Combination of Vacuum Assisted Closure Therapy and Platelet Rich Plasma for Management of Diabetic Foot Wound

Negative-pressure wound therapy to treat thoracic empyema with COVID-19-related persistent air leaks: A case report

The novel coronavirus disease (COVID-19) has resulted in a global pandemic. Recently, COVID-19-related pneumothorax has gained attention because of the associated prolonged hospital stay and high mortality. While most cases of pneumothorax respond well to conservative and supportive care, some cases of refractory pneumothorax with persistent air leaks (PALs) do not respond to conventional therapies. There is a lack of evidence-based management strategies to this regard. We describe the case of a 73-year-old man with COVID-19-related acute respiratory distress syndrome (ARDS) who developed delayed tension pneumothorax with PALs caused by alveolopleural fistulas. Despite chest tube drainage, autologous blood pleurodesis, and endoscopic procedures, the PALs could not be closed, and were complicated by thoracic empyema. Subsequent minimally invasive open-window thoracostomy (OWT) with vacuum-assisted closure (VAC) therapy helped successfully control the refractory PALs. Serial chest computed tomography monitoring was useful for the early detection of the pneumothorax and understanding of its temporal relationship with air-filled lung cysts. Our case provides a new perspective to the underlying cause of refractory pneumothorax with PALs, secondary to COVID-19-related ARDS, and underscores the potential of OWT with VAC therapy as a therapeutic alternative in such cases.

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

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

The effectiveness of vacuum-assisted closure therapy in patients with infected venous leg ulcers.

In this study, we aimed to investigate the effect of vacuum-assisted closure therapy on venous stasis wound healing in patients with chronic venous leg ulcers. Vacuum-assisted closure therapy was applied on a total of 14 venous leg ulcers. All patients had post-thrombotic syndrome. Quantitative wound culture samples were obtained before the procedure and local wound assessments were performed. The primary outcome measures included wound healing as assessed by a local wound examination during each dressing change and the rate and velocity of ulcer reduction. Wound healing was defined as the complete closure of the ulcer, while rapid wound healing was defined as a ≥ 30% reduction in the ulcer size by week four. No surgical debridement or surgical corrective procedure was applied in any patient. The mean length of hospital stay was 32.3 days. The mean number of vacuum-assisted closure therapies for each case was 17.8 and the mean time to dressing change was 72.3 hours. Multidrug-resistant Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were detected in three and four patients, respectively. Wound culture results became negative after a mean duration of vacuum-assisted closure therapy of 12.1 days. None of the patients needed antibiotic therapy until the procedure was completed. Compared to baseline, the mean ulcer reduction rates were 46.4% for the first six applications and 72.8% for the subsequent applications. Our study results suggest that vacuum-assisted closure therapy promotes rapid wound healing in patients with severe post-thrombotic syndrome with venous stasis leg ulcers, and reduces the need for antibiotics by reducing the biological burden.

Role of Vacuum-assisted closure therapy in the management of chronic wounds

Vacuum-assisted closure (VAC) therapy is a relatively new concept described in the literature that increases wound-healing capacity. The aim is to investigate the effect of vacuum-assisted closure therapy on wound healing and granulation tissue formation and hence shortening of the wound bed preparation time, reduction in duration of hospital admission, and reduction in the necessity for dressing change or for debridement. Sixty-eight patients with chronic wounds were randomized to initial treatment with vacuum-assisted closure or conventional dressings. Depending upon the condition of the wound, it was debrided and dressing changed. The rate of granulation tissue production was determined by measuring the reduction in wound volume over time. The primary endpoint was a granulated wound or preparation for wound coverage techniques. The mean wound size before treatment was 26.52 cm2 and 15.84 cm2 in VAC therapy and conventional dressing group respectively. Similarly, the mean wound size after treatment was 13.35 cm2 and 14.38 cm2 in VAC therapy and conventional dressing group respectively. The duration of treatment was 14.71 days and 23.38 days with % of wound size reduction 49.66% and 9.21% in VAC therapy and conventional dressing group respectively were statistically significant. The application of controlled levels of negative pressure has been shown to accelerate debridement and promote healing in chronic wounds. It also provides a sterile, more controlled resting environment to large exudating wound surfaces.

Modified application of vacuum-assisted closure in thoracic surgery patients

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

Comparison of Larval Therapy and Vacuum-Assisted Closure Therapy after Revascularization in Peripheral Artery Disease Patients with Ischemic Wounds.

Objective Even for very successful peripheral revascularization therapy, treatment is not complete until the ulcerative, gangrenous, and infected wound is closed. This study was performed and compared the outcomes of vacuum-assisted closure (VAC) and maggot debridement therapy (MDT) following peripheral revascularization to accelerate the wound healing process. Methods We did a prospective randomized clinical trial between January 1, 2014, and June 21, 2019. This study included 72 patients (63 males and nine females). Balloon angioplasty was performed in 21 patients (29.2%), peripheral bypass in 39 (54.2%), and both balloon angioplasty and revascularization (hybrid) surgery in 12 (16.7%). Thirty-three patients (45.8%) received 15 VAC therapy sessions for a month. Therapy progress was monitored at 48 h intervals, and wound debridement was performed. Thirty-nine patients (54.2%) received an average of six larval therapy sessions for a month. Groups were compared with the X2 test, and a statistically significant difference was found (P < 0.001). Results In the VAC therapy group (n = 33), 14 patients (42.4%) had their feet amputated, 5 (15.1%) had a toe amputated, and 4 (12.1%) had all of their toes amputated. A skin graft was performed on four patients (12.1%) who developed granulation tissue. The wounds of six patients (18.2%) undergoing VAC therapy healed. In the larval therapy group (n = 39), the wounds healed in 36 patients (92.3%), and 3 (7.7%) had a toe amputated. Conclusion Larval therapy was shown to be more effective than VAC therapy for the treatment of postrevascularization ischemic wounds. Thus, larval therapy can be used as an effective biological treatment method when major amputation is not required.

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.

Role of vacuum-assisted closure (VAC) therapy in the management of exposed mesh after ventral hernia repair.

Role of vacuum-assisted closure (VAC) therapy in the management of exposed mesh after ventral hernia repair.