2. CONTENTS
INTRODUCTION
MECHANISM OF WOUND HEALING
NOVEL CONCEPTS IN WOUND HEALING
VACUUMASSISSTED CLOSURE WOUND THERAPY
MECHANISM OF ACTION OF V
AC
METHODOLOGY
USES OF V
AC
ADVANTAGESAND DISADVANTAGES
APPLICATIONS
FUTURE DEVELPOMENT
CONCLUSION
REFERENCES
3. INTRODUCTION
Wounds may result from trauma or from a surgical incision. In
addition, pressure ulcers (also known as decubitus ulcers or bed
sores), a type of skin ulcer, might also be considered wounds.
Wound healing is the process of repair that follows injury to the
skin and other soft tissues.
The capacity of a wound to heal depends in part on its depth,
as well as on the overall health and nutritional status of the
individual.
Following injury, an inflammatory response occurs and the cells
below the dermis (the deepest skin layer) begin to increase
collagen (connective tissue) production. Later, the epithelial
tissue (the outer skin layer) is regenerated.
4. Standard wound management consists of:
Initial surgical debridement (a rapid and effective
technique to remove devitalised tissue).
Wet-to moist (WM) gauze dressings , which need to
be changed at least twice daily.
These dressings are relatively inexpensive, readily
available.
Disadvantages: non-selective debridement with
dressing removal, possible wound desiccation, and the
need for frequent dressing changes.
5. The vacuum-assisted closure (VAC) device was
pioneered by Dr Louis Argenta and Dr Michael
Morykwas in 1993.
Vacuum-assisted closure (VAC)therapy-
Alternative to the standard forms of wound
management, which incorporates the use of negative
pressure to optimise conditions for wound healing and
requires fewer painful dressing changes.
9. VACUUM ASSISSTED CLOSURE
WOUND THERAPY
The application of controlled levels of negative
pressure accelerates debridement and promote healing
in many different types of wounds.
The optimum level of negative pressure appears to be
around 125mmHg.
Negative pressure assists;
Removal of interstitial fluid.
Decreases localised oedema.
Increases blood flow.
15. METHODOLO
GY
Materials needed:
Scissors (sterile or clean)
Gloves (sterile orclean)
Dressing kit
Canister
V.A.C. Unit
Optional:
Skin prep Tincture
Benzoin
Non-adherent dressing,
such as Mepitel
16. Aggressively clean wound
Debride necrotic tissue or eschar if possible
Achieve hemostasis
Shave hair around border if needed
Irrigate wound with normal saline
Dry and prep skin as appropriate
Cut foam to size of wound
Gently lay foam in wound, including tunnels,
undermining, and allsurfaces
18. Cut
foam
Cut the foam to fit the size and shape of the wound, including tunnels and
undermined areas
19. Lay foam in
wound
Gently place the foam into the wound cavity, covering the entire
wound base and sides, tunneling and undermining
20. Cut the
drape
Cut the drape large enough to cover the foam and 3-5 cm of surrounding
healthy tissue with drape.
21. Applying the
drape
Apply the drape beginning on one side of the foam, toward the tubing. Do not
stretch the drape and do not compress the foam into the wound with drape.
This helps minimize tension or shearing forces on periwound tissue
30. ADVANTAG
ES
Provides moreeffective therapybecause target sub
atmospheric pressure is monitoredandmaintainedat
Maximizes accuracy and effectiveness of V.A.C.®
Therapy.
Reduced frequency of dressing changes.
Reduced bacterial cell count.
Enhanced dermal perfusion.
Provision of closed, moist wound
healing environment.control of odour
and exudate.
Reduction in complexity and number of
surgical procedure.
31. DISADVANTA
GES
Pain and discomfort when suction is applied initially.
Allergies toadhesive drape.
Noise of vac therapyunit.
If the wound deteriorates after the first dressing
change discontinue vac therapy.
Fulminant or incipient skin necrosis.
Excoriation of the skin if foam is not correctly cut to
use.
Drain require fixation.
32. APPLICATIO
NS
Treatment of early hip joint infections.
Post operative ascetic fluid leaks in cirrhotic patients.
Wound temporation in composite scalp and calvarial
defects.
Sea water-immersed wound treatment under different
negative pressure.
Treatment of perineal war wound related to rectum.
33. In patients with wound dehiscence after abdominal
open surgery.
Management of Postpneumonectomy Empyema.
Management of lung abscess.
Treatment of mastitis assossiated chronic breast
wounds.
34. FUTURE
DEVELOPMENT
Emerging use of V
ACtherapy in the paediatric
population. Clarification is needed on the type of foam
dressing and pressure settings to be used in these
patients.
Research is needed to establish the relationship
between negative pressure and blood flow and the
optimal pressure for wound healing.
As new negative pressure devices are developed, there
will be a need to compare the effectiveness of the
V.A.C. Therapy system with these emerging systems.
35. CONCLUSI
ON
New tool.
Convert complicated wound into simpler wound.
Improved efficacy
Safety outcomes
Limited cost effectiveness
Fewer painful dressing changes
Smoother transition from hospital to community
36. REFERE
NCE
Sziklavari Z, Grosser C, Neu R, Schemm R, Kortner A,(
2011)“Complex pleural empyema can be safely treated
with vacuum-assistedclosure." Cardiothorac Surgery, 6-
130.
Labler L, Keel M, Trentz O. (2004) V
acuum-assisted
closure (V.A.C.) for temporary coverage of soft-tissue
injury in type III open fracture of lower extremities.
European Journal of Trauma ; 30(5):305-12.
Hunter JE, Teot L, Horch R, Banwell PE (2007).
Evidence based medicine: vacuum assisted closure in
wound care management. WoundJ; 4(3): 256-69.
37. M. J. Morykwas, J. Simpson, K. Punger, A.Argenta, L.
Kremers, and J.Argenta,(2006) “Vacuum-assisted
closure: state of basic research and physiologic
foundation,” Plastic and ReconstructiveSurgery, vol.
117,no. 7, pp. 121S–126S.
Palmen M, van Breugel HN, Geskes GG, (1997). Open
window thoracostomy treatment of empyema is
accelerated by vacuum-assisted closure. Ann Thorac
Surg;88:1131-6.
