- 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 neg pressure wound therapy: does 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 effectiveness of traditional local antibiotic depot in complex wound 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 subatmospheric 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 Antibiotic Bead Pouch for Treatment of Blast Injury of 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:
- Jelly Vac:
- Jelly VAC” for Negative-Pressure Therapy for Complex Wound Closure. A Report of Two Cases
- wound vac therapy in diabetes: (see diabetes)
- references:
- Experience with Vac assisted closure negative pressure 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.