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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 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.


Wound Vac Lecture