Healing The Wound The Vac System In Woundcare

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Healing The Wound The Vac System In Woundcare

  1. 1. Healing the Wound - The VAC System In Woundcare Dr.Anshul Govila MS MRCS(Edin) Dept of Plastic Surgery . SKMC
  2. 2. <ul><li>Just another normal day in the wards </li></ul>
  3. 4. Basic wound management <ul><li>debride </li></ul>Surgical Chemical Enzymatic
  4. 5. Basic wound management <ul><li>dress </li></ul>Healing promoting substance Absorption of discharge Dirty wound sketch Clean wound sketch Maitain a moist and clean environment
  5. 6. A Dirty Wound
  6. 7. Debridement
  7. 8. A slowly healing wound
  8. 9. A traditional dressing
  9. 10. the way it works
  10. 11. A change of dressing
  11. 12. With the VAC on
  12. 13. Principle
  13. 14. History of V.A.C. Therapy <ul><li>Research started in 1989 by Dr. Louis Argenta & Prof. Michael Morykwas of Wake Forest University School of Medicine in North Carolina, USA </li></ul><ul><li>V.A.C. originally designed to treat chronic wounds </li></ul><ul><li>V.A.C. system released in Europe in 1994 </li></ul><ul><li>V.A.C. system (unit, foam, drape and canister) is patented and exclusive to KCI </li></ul><ul><li>Annals of Plastic Surgery June 1997- 175 cases </li></ul>
  14. 15. Mechanisms of Action <ul><li>Promotes granulation tissue formation </li></ul><ul><li>Stimulates localized blood flow </li></ul><ul><li>Reduces bacterial colonization </li></ul><ul><li>Provides moist wound healing environment </li></ul><ul><li>Reduces localized edema </li></ul><ul><li>Enhances epithelial migration </li></ul><ul><li>Applies negative pressure to uniformly draw wound closed (wound contraction) </li></ul>
  15. 16. <ul><li>Vacuum Assisted Closure. </li></ul><ul><li>V.A.C. is a noninvasive, active wound-closure system that uses controlled, localized negative pressure to promote healing in acute and chronic wounds . </li></ul>
  16. 17. Increased Perfusion <ul><ul><ul><li>Peak blood flow recorded at 125mmHg </li></ul></ul></ul><ul><ul><ul><ul><li>Important to maintain correct pressure </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>sensors </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>alarms </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Study helped establish original pressure protocol with PU foam (400-600micron pore-size) </li></ul></ul></ul></ul><ul><ul><ul><li>Hypothesized that reduction in edema decompresses small blood vessels and increases flow </li></ul></ul></ul>Positive effect on perfusion with 125 mmHg Negative effect on perfusion with 400 mmHg
  17. 18. Enhanced Granulation Tissue Formation <ul><li>At 125mmHg, V.A.C. significantly increased granulation tissue formation over wet-to-moist gauze </li></ul><ul><ul><li>63.3% with continuous pressure </li></ul></ul><ul><ul><li>103.4% with intermittent pressure </li></ul></ul><ul><ul><li>Vacuum-Assisted Closure: A New Method for Wound Control and Treatment: Animal Studies and Basic Foundation Morykwas e.a. Annals of Plastic Surgery Vol 38, No 6, 1997 </li></ul></ul>
  18. 19. Reduction of Bacteria <ul><ul><li>All pigs (control and VAC) were infected with 10 8 organisms /g tissue </li></ul></ul><ul><ul><li>V.A.C. wounds exhibited significant decrease in number of microorganisms (<10 5 ) on day 4-5, vs. day 11 for control group (bacteria colonization reduced 1000X on days 4-5) </li></ul></ul><ul><ul><li>V.A.C.’s increase in perfusion and oxygenation likely enhances resistance to infection </li></ul></ul><ul><ul><li>Vacuum-Assisted Closure: A New Method for Wound Control and Treatment: Animal Studies </li></ul></ul><ul><ul><ul><li>and Basic Foundation Morykwas e.a. Annals of Plastic Surgery Vol 38, No 6, 1997 </li></ul></ul></ul>
  19. 20. Reduction of Inhibitory Factors <ul><ul><ul><li>Reduction of edema has positive effect in wound healing </li></ul></ul></ul><ul><ul><ul><li>Reduction of inhibitory factors contained in third space fluid (chemical) </li></ul></ul></ul><ul><ul><ul><li>Decompression of small blood vessels, which restores flow (mechanical) </li></ul></ul></ul><ul><ul><ul><li>Inhibition of Cell Proliferation by Chronic Wound Fluid Brian Bucalo MD, William H Eaglestein, MD, Vincent Falanga, MD 1993 Wound Repair and Regeneration </li></ul></ul></ul>
  20. 21. Tension Stress Effect <ul><ul><li>Morykwas hypothesis : mechanical stress (contraction of wound) helps cause granulation tissue formation (tissue growth) </li></ul></ul><ul><ul><li>Tissue stress effect similar to using Ilizarov technique and soft-tissue expanders to increase mitotic rates </li></ul></ul><ul><ul><li>Intermittent application results in repetive release of second messengers, further enhancing gran tissue formation </li></ul></ul><ul><ul><li>The tension-stress effect on the genesis and growth of tissues. Part 1 Ilizarov GA Clin Orthop Rel Res 1989;238:249-281 </li></ul></ul>
  21. 22. Acute Surgical Wounds Pressure Ulcers Diabetic Wounds
  22. 23. Open Abdominal Wounds
  23. 24. <ul><li>Skin Grafts </li></ul><ul><li>Partial Thickness Burns </li></ul>
  24. 25. Indications <ul><li>Acute Surgical Wounds </li></ul><ul><li>Pressure Ulcers </li></ul><ul><li>Ortho Trauma Wounds </li></ul><ul><li>Diabetic Wounds </li></ul><ul><li>Skin Grafts </li></ul><ul><li>Open Abdominal Wounds </li></ul><ul><li>Partial Thickness Burns </li></ul>
  25. 26. Contraindications <ul><li>Malignancy in the wound </li></ul><ul><li>Sometimes used to control drainage for terminal patients </li></ul><ul><li>Fistulas to organs or body cavities </li></ul><ul><li>Osteo myelitis </li></ul><ul><li>Exposed arteries or veins </li></ul>
  26. 27. A Very simple Analogy Pump Canister Sponge Pump Canister Sponge
  27. 28. Pump
  28. 29. Sponge <ul><li>Polyurethane Foam </li></ul><ul><li>Poly-vinyl-alcohol </li></ul><ul><li>0.2 to 1mm </li></ul>Pore size: 400-600 microns Available with or without embedded drains
  29. 30. T.R.A.C. ™ Tubing <ul><li>multi-lumen </li></ul>For Fluid For Measurement
  30. 31. T.R.A.C.™ Technology Therapeutic Regulated Accurate Care <ul><li>Continuous feedback system that constantly monitors the negative pressure at the wound site, compares it with the target pressure, and adjusts accordingly, so that the wound site pressure is equal to the target pressure. </li></ul>
  31. 32. <ul><li>Provides more effective therapy because target sub atmospheric pressure is monitored and maintained at Maximizes accuracy and effectiveness of V.A.C. ® Therapy ™ </li></ul><ul><li>Ensures controlled, consistent and safe V.A.C. ® the wound site, even during patient movement </li></ul><ul><li>Enables the User to adjust the rate of negative pressure once the foam is compressed in the wound to meet individual patients’ needs and increase patient comfort </li></ul><ul><li>T.R.A.C. ™ System alerts the User of tubing blockages and pressure leakages to maximize patient safety </li></ul>Advantages
  32. 33. How to put on a VAC <ul><li>Materials needed: </li></ul><ul><li>Scissors (sterile or clean) </li></ul><ul><li>Gloves (sterile or clean) </li></ul><ul><li>Dressing kit </li></ul><ul><li>Canister </li></ul><ul><li>V.A.C. Unit </li></ul><ul><li>Optional: </li></ul><ul><li>Skin prep Tincture Benzoin </li></ul><ul><li>Non-adherent dressing, such as Mepitel </li></ul>
  33. 34. How to put on a VAC <ul><li>Aggressively clean wound </li></ul><ul><li>Debride necrotic tissue or eschar if possible </li></ul><ul><li>Achieve hemostasis </li></ul><ul><li>Shave hair around border if needed </li></ul><ul><li>Irrigate wound with normal saline </li></ul><ul><li>Dry and prep skin as appropriate </li></ul><ul><li>Cut foam to size of wound </li></ul><ul><li>Gently lay foam in wound, including tunnels, undermining, and all surfaces </li></ul>
  34. 35. Clean Wound Thoroughly Aggressive cleaning of the wound at each dressing change is imperative to decrease bacterial load and minimize odor
  35. 36. Cut Foam Cut the foam to fit the size and shape of the wound, including tunnels and undermined areas
  36. 37. Lay Foam in Wound Gently place the foam into the wound cavity, covering the entire wound base and sides, tunneling and undermining
  37. 38. Cut the Drape Cut the drape large enough to cover the foam and 3-5 cm of surrounding healthy tissue with drape.
  38. 39. 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.
  39. 40. Foam and Drape Important: Foam should not overlap on to intact skin.
  40. 41. Applying the suction tubing Cut hole in drape about 1.5 cm and apply tubing
  41. 42. Applying the suction tubing
  42. 43. Connect to Canister Connect dressing tubing to canister tubing, making sure clamps are open
  43. 44. Y-Connecting A Y-connector is available to connect 2 or more wounds to one V.A.C. pump
  44. 45. V.A.C. Canister Canister has graduated marks to measure exudate. Change at least once per week or when full.
  45. 46. Canister with Isolyser Canister comes with Isolyser gel that gels fluid on contact and helps eliminate odor
  46. 47. Dressing in Place with Therapy OFF
  47. 48. Dressing with Therapy ON Therapy is turned on and foam is pulled down into wound
  48. 49. Adjusting V.A.C. Pressure <ul><li>May turn down (minimum 75 mmHg) when: </li></ul><ul><ul><li>Unrelieved pain </li></ul></ul><ul><ul><li>Bruising in wound bed </li></ul></ul><ul><ul><li>Elderly and nutritionally compromised patient </li></ul></ul><ul><ul><li>Excessive bleeding </li></ul></ul><ul><ul><li>Compromised circulation ( PVD ) </li></ul></ul><ul><ul><li>Excessive granulation tissue growth </li></ul></ul>
  49. 50. Adjusting V.A.C. Pressure <ul><li>May turn pressure up when: </li></ul><ul><ul><li>Excessive drainage </li></ul></ul><ul><ul><li>Large wound volume </li></ul></ul><ul><ul><li>Using V.A.C. Soft-Foam </li></ul></ul><ul><ul><li>Difficulties maintaining a seal </li></ul></ul>
  50. 51. Continuous vs. Intermittent <ul><li>Continuous therapy : </li></ul><ul><ul><li>Always for at least first 48 hours </li></ul></ul><ul><ul><li>Maintain for length of treatment when: </li></ul></ul><ul><ul><ul><li>Significant discomfort in intermittent mode </li></ul></ul></ul><ul><ul><ul><li>High amounts of exudate </li></ul></ul></ul><ul><ul><ul><li>Wound requires constant contraction (sternal wounds, tunnels) </li></ul></ul></ul><ul><li>Intermittent therapy </li></ul><ul><ul><li>Use to stimulate granulation tissue faster </li></ul></ul>
  51. 52. V.A.C. Alarms <ul><li>Low pressure (leak) alarm (delayed) </li></ul><ul><li>Therapy NOT ON alarm (delayed 15 minutes ) </li></ul><ul><li>Canister full alarm </li></ul><ul><li>Canister out alarm </li></ul><ul><li>Unit tilt alarm </li></ul><ul><li>Alarm delay button will temporarily delay audible alarm </li></ul><ul><li>If cause of alarm is not resolved within 5 minutes, unit automatically shuts off </li></ul>
  52. 53. Battery Back-Up V.A.C. can run off an internal battery. Clips to the end of bed or IV pole.
  53. 54. Infected Wounds <ul><li>V.A.C. can be used on infected wounds </li></ul><ul><li>Change dressings more often until clinical signs of infection go away ( usually 3-5 days) </li></ul><ul><li>Be sure to keep therapy ON </li></ul><ul><li>Be sure to clean wound aggressively at dressing change </li></ul>
  54. 55. Wound Healing : Progression <ul><li>Decrease in overall wound volume should be noted from week to week </li></ul><ul><li>Wound should become “ beefy red ” initially </li></ul><ul><li>Wound may look larger at beginning because of removal of edema </li></ul><ul><li>May be oozing of blood from disruption of capillary buds as granulation tissue develops </li></ul><ul><li>Wound should become redder as granulation tissue increases </li></ul>
  55. 56. Wound Healing : Progression <ul><li>Color of wound may then become paler as amount of collagen in wound increases </li></ul><ul><li>Likely gradual decrease in exudate levels </li></ul><ul><li>New epithelial growth should be evident at viable wound edges </li></ul>
  56. 57. Bridging Practical Tips:
  57. 58. Wound Won’t Seal <ul><li>Leaks generally make whistling sounds ; listen closely for them </li></ul><ul><li>Check around connector and tubing first </li></ul><ul><li>Gently pat around perimeter of wound to seal off air leaks </li></ul><ul><li>May need to seal over drain holes </li></ul><ul><li>If you can’t hear it, sometimes listening with stethoscope can pinpoint leak </li></ul>Practical Tips:
  58. 59. When to Discontinue Therapy <ul><li>When goal of therapy has been met </li></ul><ul><ul><li>Most of the time V.A.C. used to prepare wound for surgery </li></ul></ul><ul><ul><li>Sometimes V.A.C. will take wound to full closure </li></ul></ul><ul><li>When wound shows no progress for 1-2 weeks </li></ul>
  59. 60. Abdomen
  60. 61. Exposed metal
  61. 62. In Burns
  62. 63. With the application of Integra TM
  63. 64. Summary <ul><li>New tool </li></ul><ul><li>Convert complicated wound into simpler wound </li></ul><ul><li>Another step in the reconstructive ladder </li></ul>
  64. 65. Thank you
  65. 66. Abdullah enjoying his wheelchair ride with his VAC on

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