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Key Points Controlled levels of negative pressure accelerate debridement and promote healing. From animal studies a negative pressure value of mmHg appears to be optimum when applied in a cyclical fashion.
Technique can be used in the Vacuum assisted wound closure essay of many types of soft tissue injuries including degloving injuries, donor sites, infected sternotomy wounds and various soft tissue injuries prior to surgical closure, grafting or reconstructive surgery. Although the cost of VAC treatment is not insignificant, there is some evidence to suggest that it compares favourably with other more conventional therapies.
Abstract The application of controlled levels of negative pressure has been shown to accelerate debridement and promote healing in many different types of wounds. The optimum level of negative pressure appears to be around mmHg below ambient and there is evidence that this is most effective if applied in a cyclical fashion of five minutes on and two minutes off.
It is believed that the negative pressure assists with removal of interstitial fluid, decreasing localised oedema and increasing blood flow. This in turn decreases tissue bacterial levels. Additionally, mechanical deformation of cells is thought to result in protein and matrix molecule synthesis, which increases the rate of cell proliferation.
Despite the significant costs involved, the technique is said to compare favourably in financial terms with conventional treatments in the management of difficult to heal wounds.
Introduction Vacuum assisted closure also called vacuum therapy, vacuum sealing or topical negative pressure therapy is a sophisticated development of a standard surgical procedure, the use of vacuum assisted drainage to remove blood or serous fluid from a wound or operation site.
In essence the technique is very simple. A piece of foam with an open-cell structure is introduced into Vacuum assisted wound closure essay wound and a wound drain with lateral perforations is laid on top of it.
The entire area is then covered with a transparent adhesive membrane, which is firmly secured to the healthy skin around the wound margin. When the exposed end of the drain tube is connected to a vacuum source, fluid is drawn from the wound through the foam into a reservoir for subsequent disposal.
The plastic membrane prevents the ingress of air and allows a partial vacuum to form within the wound, reducing its volume and facilitating the removal of fluid.
The foam ensures that the entire surface area of the wound is uniformly exposed to this negative pressure effect, prevents occlusion of the perforations in the drain by contact with the base or edges of the wound, and eliminates the theoretical possibility of localised areas of high pressure and resultant tissue necrosis.
Development of the vacuum assisted closure technique The practice of exposing a wound to sub-atmospheric pressure for an extended period to promote debridement and healing was first described by Fleischmann et al in following the successful use of this technique in 15 patients with open fractures.
They reported that the treatment resulted in "efficient cleaning and conditioning of the wound, with marked proliferation of granulation tissue". No bone infections occurred in any of the patients although one developed a soft tissue infection, which subsequently resolved with further treatment.
In two further papers, Fleischmann and colleagues described the treatment of 25 patients with compartment syndromes of the lower limb  and patients with acute and chronic infections of various types . The average duration of the vacuum therapy treatment for the patients with compartment syndrome was One patient developed a superficial wound necrosis, which healed spontaneously without invasive surgical treatment.
The average duration of vacuum therapy in the treatment of the patients with infected wounds was Of the wounds with acute infections the majority were subsequently closed by secondary suturing Infection recurred in 3.
Further success with topical negative pressure treatment in Germany was reported by Muller  following the treatment of patients with infected wounds, and in Kovacs et al  described how 'vacuum sealing' could be used for the treatment of chronic radiation ulcers.
The results of a prospective trial involving 45 patients with soft tissue injuries including sacral pressure ulcers, acute traumatic soft tissue defects and infected soft tissue defects following rigid stabilisation of lower extremity fractures were described by Mullner et al.
In the early studies, negative pressure within the wound was achieved by the use of conventional methods such as wall suction apparatus or surgical vacuum bottles.
Both these systems are associated with practical problems in terms of the delivery, control and maintenance of the required levels of negative pressure, as discussed by Banwell et al . Ina commercial system for promoting vacuum assisted closure VAC was introduced into the United States market.
The heart of the system is a microprocessor-controlled vacuum unit that is capable of providing controlled levels of continuous or intermittent sub-atmospheric pressure ranging from 25 to mmHg.
Two types of unit are available, a mains operated system with a canister volume of ml for patients with limited mobility or very heavily exuding wounds, and a lightweight, battery-powered unit with a canister volume of 50 ml that can delivery therapy to the fully ambulatory patient with minimal to moderate levels of exudate.
This system has a battery life of about 17 hours. The large system is fitted with various audible and visual alarms to indicate if the unit is tipped greater than 45 degrees, the canister is full, or the dressing has an air leak. In a seminal paper Morykwas et al addressed both of these issues following a series of animal studies.
Deep circular defects, 2. In the first series of experiments, a laser Doppler technique was used to measure blood flow in the subcutaneous tissue and muscle surrounding the wounds as these were exposed to increasing levels of negative pressure, applied both continuously and intermittently.
Their results indicated that whilst an increase in blood flow equivalent to four times the baseline value occurred with negative pressure values of mmHg, blood flow was inhibited by the application of negative pressures of mmHg and above. A negative pressure value of mmHg was therefore selected for use in subsequent studies.
The rate of granulation tissue production under negative pressure was determined using the same model by measuring the reduction in wound volume over time.
Compared with control wounds dressed with saline soaked gauze, significantly increased rates of granulation tissue formation occurred with both continuous The observation that intermittent or cycled treatment appears more effective than continuous therapy is interesting although the reasons for this are not fully understood.
Two possible explanations were advanced by Philbeck et al .Use of Vacuum Assisted Closure Therapy in the Treatment of Diabetic Foot Wounds Authors: Luca Dalla Paola 1, Anna Carone 2, p = ) and reduced time to complete closure of the wound was found with VAC Therapy (65±16 days in V2 group vs 98±45 days in C2 group, p = ).
Total time required for surgical procedures was. Use of Vacuum Assisted Closure Therapy in the Treatment of Diabetic Foot Wounds Authors: Luca Dalla Paola 1, Anna Carone 2, p = ) and reduced time to complete closure of the wound was found with VAC Therapy (65±16 days in V2 group vs 98±45 days in C2 group, p = ).
Total time required for surgical procedures was. The physician is responsible for applying the KCI Vacuum Assisted Closure device, initiating dressing and dressing change.
The RN (Registered Nurse) is responsible for documenting the wound assessment at the time of dressing change, including wound bed appearance, condition . Vacuum-assisted closure of a wound is a type of therapy to help wounds heal.
It’s also known as wound VAC. During the treatment, a device decreases air pressure . In advanced wound healing, vacuum-assisted closure is used to help drain blood or fluid from a nonhealing wound.
First, a special piece of foam with a tube on top is inserted into the wound. Then, the wound area is covered and sealed with an adhesive covering, with only the tube exposed.
Wound Closure: Vacuum Assisted Closure Therapy (V.A.C.) a foam dressing, which is placed in the cavity of the wound (Medica, ). The other end of the tube is attached to a canister th.