This document provides an overview of wound healing and vacuum assisted closure (VAC) therapy. It discusses the standard process of wound healing, novel wound dressing concepts, and how VAC therapy works by applying negative pressure to wounds to promote granulation tissue formation, blood flow, and wound contraction. The document outlines the methodology for VAC application and reviews its uses for different wound types as well as advantages like reduced dressing changes and bacteria. It also discusses future developments and concludes that VAC is a new and improved tool to help convert complicated wounds into simpler wounds.

2. Presented by Guide:
BINUJA S.S. PRASANTH M.S

3. CONTENTS
 INTRODUCTION
 MECHANISM OF WOUND HEALING
 NOVEL CONCEPTS IN WOUND HEALING
 VACUUM ASSISSTED CLOSURE WOUND THERAPY
 MECHANISM OF ACTION OF VAC
 METHODOLOGY
 USES OF VAC
 ADVANTAGES AND DISADVANTAGES
 APPLICATIONS
 FUTURE DEVELPOMENT
 CONCLUSION
 REFERENCES

4. 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.

5. 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.

6. 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.

7. MECHANISM OF WOUND HEALING

9. NOVEL CONCEPTS IN WOUND HEALING
 Wound dressing
 Dry dressing
 Wet-to-dry dressing
 Foam dressing
 Alginate dressing
 Hydro-fibre dresssing
 Transparent film dressings
 Hydrogel dressing
 Hydrocolloid dressing

10. 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 125 mmHg.
 Negative pressure assists;
Removal of interstitial fluid.
Decreases localised oedema.
Increases blood flow.

11. MECHANISM OF ACTION
 Promotes granulation tissue
formation .
 Stimulates localized blood
flow .
 Reduces bacterial colonization
 Provides moist wound
healing environment
 Reduces localized edema
 Enhances epithelial migration
 Applies negative pressure to
uniformly draw wound
closed (wound contraction)

12. VAC SYSTEM

13. VAC PUMP

14. SPONGE
Polyurethane Foam Poly-vinyl-alcohol
Pore size:400-600 microns Pore size: 0.2 -1mm

15. Tube
For fluid For measurement
Multi-lumen

16. METHODOLOGY
Materials needed:
 Scissors (sterile or clean)
 Gloves (sterile or clean)
 Dressing kit
 Canister
 V.A.C. Unit
Optional:
 Skin prep Tincture
Benzoin
 Non-adherent dressing,
such as Mepitel

17. 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 all surfaces

18. 1.Clean wound thoroughly
Aggressive cleaning of the wound at each dressing change is
imperative to decrease bacterial load and minimize odor

19. Cut foam
Cut the foam to fit the size and shape of the wound, including tunnels and
undermined areas

20. Lay foam in wound
Gently place the foam into the wound cavity, covering the entire
wound base and sides, tunneling and undermining

21. Cut the drape
Cut the drape large enough to cover the foam and 3-5 cm of surrounding
healthy tissue with drape.

22. 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

23. Applying the suction tubing
Cut hole in drape about 1.5
cm and apply tubing

24. Connect to canister
Connect dressing tubing to canister tubing, making sure clamps are open

25. Y - connecting
A Y-connector is available to connect 2 or more wounds to one V.A.C. pump

26. Canister CANISTER WITH ISOLYSER
Canister comes with Isolyser gel that gels fluid on contact and helps
eliminate odor

27. USES OF VAC THRAPY
1. Acute Surgical Wounds

28. 2. Pressure Ulcers

29. 3. Diabetic Wounds

30. 4. Open Abdominal Wounds

31. ADVANTAGES
 Provides more effective therapy because target sub
atmospheric pressure is monitored and maintained at
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.

32. DISADVANTAGES
 Pain and discomfort when suction is applied initially.
 Allergies to adhesive drape.
 Noise of vac therapy unit.
 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.

33. APPLICATIONS
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.

34. In patients with wound dehiscence after abdominal
open surgery.
Management of Postpneumonectomy Empyema.
Management of lung abscess.
Treatment of mastitis assossiated chronic breast
wounds.

35. FUTURE DEVELOPMENT
 Emerging use of VAC therapy 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.

36. CONCLUSION
 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

37. REFERENCE
 Sziklavari Z, Grosser C, Neu R, Schemm R, Kortner A,(
2011) “Complex pleural empyema can be safely treated
with vacuum-assisted closure." Cardiothorac Surgery, 6-
130.
 Labler L, Keel M, Trentz O. (2004) Vacuum-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. Wound J ; 4(3): 256-69.

38.  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 Reconstructive Surgery, 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.