Wound Vac

- Discussion: 
     - KCI Vacuum Assisted Closure Device: (Company Web Site) and V.A.C.® Therapy Indications and Safety Information
     - Soft Tissue Coverage (Austere Environment) – Flaps and Vacuum-Assisted Closure (VAC)

      - technique:
            - debride all devitalized tissue and contaminated material;
            - sterile reticulated polyurethane sponge is cut to conform with the surface of the wound; 
            - ensure that the deepest portions of the wound are in contact with the sponge;
            - spone makes contact with the entire wound surface;
            - fenestrated end of the tube is placed on surface of sponge;
            - adhesive plastic sheet is applied over the skin, sponge, and around the tubing (sealing the vacuum);
            - egress tube runs from the sponge to VAC pump device;
            - vacuum can be set from neg 50 to neg 200 mm Hg;
            - continuous setting of 125 mm Hg is most common;
            - sponge is changed every 48 hours (except for skin grafts in which sponge is removed at day 4);
     - basic science: 
            - may reduce pseudomonas colonization more than staph aureus.
            - references:
                    - Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation.
                    - Bacterial load in relation to vacuum-assisted closure wound therapy: a prospective randomized trial.
                    - Quantifying bacterial bioburden during negative pressure wound therapy: does the wound VAC enhance bacterial clearance? 
                    - Negative pressure wound therapy reduces pseudomonas wound contamination more than Staphylococcus aureus.
     - additional considerations:
            - flaps and reconstructive techniques 
            - combination of wound vac and antibiotic bead pouch
                   - references:
                            - Negative pressure wound therapy reduces the effectiveness of traditional local antibiotic depot in a large complex musculoskeletal wound animal model.
                            - Effect of negative pressure wound therapy on the elution of antibiotics from polymethylmethacrylate beads in a porcine simulated open femur fracture model.
            - postoperative arthroplasty wound / high risk dressings
            - wound management


- Indications in Specific Conditions:

    - incisional negative wound therapy
    - extremity trauma and open fractures: (see open fractures and open tibia fractures
         - references:
                - The use of a neg pressure dressing to salvage a Gustilo grade IIIB open tibial fracture with concomitant osteomyelitis to avert a free flap.
                - The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone.
                - Vacuum-Assisted Wound Closure (VAC Therapy) for the Management of Patients With High-Energy Soft Tissue Injuries. 
                - The use of subatmospheric pressure dressing for the coverage of radial forearm free flap donor-site exposed tendon complications. 
                - Vacuum-assisted complex wound closure with elastic vessel loop augmentation: a novel technique.
                - Vacuum-Assisted Wound Closure (VAC Therapy) for the Management of Patients With High-Energy Soft Tissue Injuries.
                - [The V.A.C. system (vacuum assisted closure) as bridging between primary osteosynthesis in conjunction with functional reconstructed of soft tissue--open fractures type 2 and type 3]. 
                - Experience With Wound VAC and Delayed Primary Closure of Contaminated Soft Tissue Injuries in Iraq. 
                - Negative pressure wound therapy after severe open fractures: a prospective randomized study
                - The use of negative-pressure wound therapy (NPWT) in the temporary treatment of soft-tissue injuries associated with high-energy open tibial shaft fractures.
                - Comparison of Vacuum-assisted Closure to the Antibiotic Bead Pouch for the Treatment of Blast Injury of the Extremity
                - Commentary: Comparison of Vacuum-assisted Closure to the Antibiotic Bead Pouch for the Treatment of Blast Injury of the Extremity
                - Trephination and subatmospheric pressure therapy in the management of extremity exposed bone.
                - Delayed flap coverage of open extremity fractures after previous vacuum-assisted closure (VAC) therapy - worse or worth?
                - Use of Vacuum-assisted Closure in Pediatric Open Fractures With a Focus on the Rate of Infection
                - Negative pressure therapy in acute complex lower limb injuries: downgrading reconstructive requirements in high risk patients
                - Description of a technique for vacuum-assisted deep drains in the management of cavitary defects and deep infections in devastating military and civilian trauma.
                - Delayed Flap Reconstruction With Vacuum-Assisted Closure Management of the Open IIIB Tibial Fracture
                - Effect of NP Wound Therapy on the Elution of Antibiotics From Beads in a Porcine Simulated Open Femur Fracture Model  
                - Modern papineau technique with vacuum-assisted closure
                - Negative Pressure Wound Therapy in Grade IIIB Tibial Fractures: Fewer Infections and Fewer Flap Procedures?
                - Subatmospheric pressure dressings in the temporary treatment of soft tissue injuries associated with type III open tibial shaft fractures in children.



- Misc:

    - wound vac therapy in diabetes: (see diabetes
         - references:
                - Experience with the vacuum assisted closure negative pressure technique in the treatment of non-healing diabetic and dysvascular wounds. 
    - wound vac therapy for STSG: (see STSG
         - references:
                - The vacuum assisted closure device: a method of securing skin grafts and improving graft survival.
                - Ambulant vacuum-assisted closure of skin-graft dressing in the lower limbs using a portable mini-VAC device. 
    - complications of wound vac therapy in orthopaedics: 
         - references: 
               - Vacuum-assisted closure complicated by erosion and hemorrhage of the anterior tibial artery. 
               - Comparison of Vacuum-assisted Closure to the Antibiotic Bead Pouch for the Treatment of Blast Injury of the Extremity
               - Rare complication after VAC-therapy in the treatment of deep sore ulcers in a paraplegic patient.
               - Deaths, Injuries Linked to Negative Pressure Wound Therapy Systems
               - Negative Pressure Wound Therapy (NPWT) systems - Preliminary Public Health Notification
               - V.A.C.® Therapy Indications and Safety Information
               - The incidence of wound complications related to negative pressure wound therapy power outage and interruption of treatment in orthopaedic trauma patients
               - Early soft tissue coverage and negative pressure wound therapy optimises patient outcomes in lower limb trauma.


Wound Vac Lecture




Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Sunday, August 23, 2015 6:38 am