Vac therapy a valuable adjunct to wound care armamentarium

1. VAC Therapy: A valuable adjunct to wound care armamentarium? Muhammad Saaiq
Editorial
VAC Therapy: A Valuable Adjunct
to Wound Care Armamentarium
Muhammad Saaiq
Assistant Professor
Plastic surgery and Burn Care
Centre, PIMS, Islamabad.
E-mail
muhammadsaaiq5@gmail.com
Medicine is an ever evolving science. The present day
medicine is termed as evidence based medicine
wherein practice and policies are guided by sound
clinical and experimental evidence supporting the
benefits and safety of a given therapeutic modality. Over
the last decade, Vacuum Assisted Closure therapy
(VAC therapy) has emerged as a novel adjunct to the
management of surgical wounds across a range of
specialties. 1-3
How does the VAC therapy work?
Since the technique is relatively new, its exact
mechanism of action still continues to be researched. A
variety of interrelated factors have been identified to
account for its favorable effects on wound healing.
These factors can be summarized into three subgroups
i.e. removing, reducing and Improving. Firstly the
edematous tissue planes surrounding the wound are
characterized by localized collection of interstitial fluid
that contains inhibitory factors that suppress mitosis,
fibroblasts activity, collagen production, and cell growth.
The VAC therapy actively withdraws this fluid and its
constituent inhibitory factors. Secondly the VAC
therapy reduces the bacterial counts of the wound to a
level far lower than what can cause infection. Thirdly
VAC therapy improves the entire healing process
through its direct and indirect effects. With removal of
local edema, the microcirculation and lymphatic/ venous
drainage is reestablished. The delivery of oxygen and
nutrients to the wound is optimized. The
micromechanical forces of low pressure suction exerts
an Ilizarovian effect at cellular level, resulting in
increased expression of mRNA and protein synthesis.
There is increased Angiogenesis. The moist
environment provided by VAC technique promotes
granulation tissue formation and healing. 4-6
The wound
if small is thus encouraged to close spontaneously.
Larger and complex wounds are rendered suitable for
definitive reconstruction with skin graft or flap.
How can the VAC therapy be applied
to a wound? Not surprisingly with growing
understanding of the mechanism involved, one can
easily construct a VAC dressing at bed side and
convert an open wound into a close controlled one.
Before its application to the wound, once must make
sure that wound is first adequately debrided with
excision of all devitalized tissues. Two sheets of
synthetic foam are then tailored the size and shape of
the wound and the wound is covered with them with a
Redivac suction drain placed between the two sheets.
A transparent sealing plastic membrane sheet such as
Opsite or plastic food wrap is then applied to the foam
layers, making the system water tight and air tight. The
suction drain is connected to Suction machine or wall
vacuum suction maintained at 50-120 mmHg. It is
maintained for five days, at which point the VAC
dressing is removed. A fresh VAC dressing may be
applied for another five days and the wound re-
evaluated for further definitive management. 1
What kind of wounds are suitable for
VAC therapy? In fact the VAC therapy finds
almost universal applicability across a range of wounds,
with only few contraindications such as malignancy,
bleeding diathesis and exposed major blood vessels.
When employed, VAC therapy helps to temporize
wounds, giving time for stabilization of the patient until
complex reconstructive procedures can be instituted on
a prepared wound bed. It is effective both in the
preparatory phase of wound prior to any reconstruction
and as postoperative dressings for securing skin grafts
especially in wounds on difficult anatomic locations. 1, 7-10
Owing to its low cost, VAC therapy provides an
economical alternative to the other available costly local
wound management measures. Such economic
implications of wound management are particularly
important in the context of our limited health budgets. It
also reduces the need for daily change of dressing thus
comforting the patients on one hand and reducing the
work load of the staff responsible for wound dressings
on the other hand. With expeditious wound healing, the
overall hospital stay of the patients is also reduced. 1
Given the growing body of quality evidence, VAC
therapy should be adequately employed particularly in
the problem wounds and in the problem patients such
as those with diabetes mellitus and peripheral vascular
disease. Nonetheless once must not forget that it is an
adjunct to other established wound care measures such
as thorough debridement and not a substitute for them.
Ann. Pak. Inst. Med. Sci. 2006; 2(1): 72

2. VAC Therapy: A valuable adjunct to wound care armamentarium? Muhammad Saaiq
References
1. Saaiq M, Din HU, Khan MI, Chaudhery SM. Vacuum-assisted closure
therapy as a pretreatment for split thickness skin grafts. J Coll
Physicians Surg Pak. 2010; 20(10):675-9.
2. Baillot R, Cloutier D, Montalin L. Impact of deep sternal wound
infection management with vacuum-assisted closure therapy followed
by sternal osteosynthesis: a 15-year review of 23,499 sternotomies.
Eur J Cardiothorac Surg. 2010; 37(4):880-7.
3. Blume P, Walters J, Payne W. Comparison of negative pressure
wound therapy using vacuum-assisted closure with advanced moist
wound therapy in the treatment of diabetic foot ulcers: a multicenter
randomized controlled trial. Diabetes Care 2008; 31(4):631-6.
4. Morris GS, Brueilly KE, Hanzelka H. Negative pressure wound therapy
achieved by vacuum-assisted closure: evaluating the assumptions.
Ostomy Wound Manage. 2007; 53: 52–7.
5. Ubbink DT, Westerbos SJ, Nelson EA, Vermeulen H. A systematic
review of topical negative pressure therapy for acute and chronic
wounds. Br J Surg. 2008;95(6):685-92.
6. Saxena V, Hwang CW, Huang S, Eichbaum Q, Ingber D, Orgill DP.
Vacuum-assisted closure: microdeformations of wounds and cell
proliferation. Plast Reconstr Surg 2004; 114:1086-96.
7. Penn-Barwell JG, Fries CA, Street L, Jeffery S. Use of topical negative
pressure in British servicemen with combat wounds. ePlasty 2011;11:
354-63.
8. Nather A, Chionh SB, Han AYY,1 Chan PPL, Nambiar A. Effectiveness
of Vacuum-assisted Closure (VAC) Therapy in the Healing of Chronic
Diabetic Foot Ulcers. Ann Acad Med 2010 ;39 ( 50): 353-8.
9. Stannard JP, Volgas DA, Stewart R, McGwin G, Alonso JE. Negative
pressure wound therapy after severe open fractures: a prospective
randomized study. J Orthop Trauma. 2009;23(8):552-7.
10. Petkar KS, Dhanraj P, Kingsly PM, Sreekar H, Lakshmanarao A,
Lamba S, et al. A prospective randomized controlled trial comparing
negative pressure dressing and conventional dressing methods on
split thickness skin grafts in burned patients. Burns 2011;37:925-9.
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Ann. Pak. Inst. Med. Sci. 2006; 2(1): 73