Vacuum therapy for wound management

Vacuum assisted wound closure (VAC) is a closed system, which applies negat ive pressure to the wound tissues. Basic studies have shown beneficial effe cts on wound blood flow and proliferation of healing granulation tissue. Th eoretically, the method acts by removal of excess tissue fluid from the ext ravascular space, which lowers capillary afterload and thereby promotes the microcirculation during the early stages of inflammation. Additionally, th e mechanical effect of the vacuum on the tissue at the wound surface appear s to have an "llizarovian" effect resulting in an exuberant proliferation o f healing granulation tissue. This technique has been used in over 2560 patients at the author's institut ion over the past 10 years for an expanding list of wound applications in s everal surgical disciplines. Commonly used orthopedic indications include t raumatic wounds following debridement, infection (following debridement), f asciotomy wounds for compartment syndrome, and as a dressing for anchoring an applied split thickness skin graft. The author's personal experience consists of 269 patients treated and has n ot been associated with any major complications. A low incidence (2.5%) of localized superficial skin irritation occurred when a portion of the vacuum sponge overlapped the affected area. This problem is avoided by carefully confining the sponge to the wound tissue and avoiding the overlap of normal skin. The technique is contraindicated in patients with an allergy to any of the components which contact the skin such as the polyurethane sponge, t he adhesive, or the plastic film applied to seal the system to the skin aro und the wound. Patients whose skin is thin and easily damaged will not tole rate the pulling off of the adhesive film, which is done at the time of spo nge removal/change. Also, patients who are fully anticoagulated or patients with large wound surface areas (e.g., burns) may need careful monitoring o f electrolytes, hematocrit, and/or fluid balance in an intensive care or bu rn unit setting. The mainstay of wound care is debridement, and vacuum assisted wound closur e is not a substitute for this. ft is a novel and welcome addition to the m ethods available to surgeons charged with the management of challenging wou nds, and its final role in the overall list of adjunctive wound treatment m odalities is still seeking a final definition.