Vacuum compression therapy (vct)


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Vacuum compression therapy (vct)

  2. 2. VACUUM COMPRESSION THERAPY(VCT)  Vasotrain-447- a machine with cycles of vacuum and subsequent compression  Venous drainage enhancement during compression phase (positive pressure)  Stimulation of the arterial inflow during the suction phase (negative pressure)  Reduces interstitial oedema formation which may hamper microcirculatory perfusion.
  3. 3. EFFECTS OF VACUUM-COMPRESSIONTHERAPY ON HEALING OF DIABETICFOOT ULCERS: RANDOMIZED CONTROLTRIAL Asghar Akbari, PhD; Hesam Moodi, BSc; Fatemeh Ghiasi, MSc; Hamidreza Mahmoudzadeh Sagheb, PhD; Homayra Rashidi, MDJournal of rehabilitation research & development(JRRD),vol 44, No 5,2007, pages 631-636Single blinded- level B evidence study
  4. 4. RANDOMIZED CONTROL TRIAL(RCT) Participants are randomized to treatment groups Characteristics of the participants in the groups should be similar, so that any difference in outcome can be more reliably attributed to the effects of the treatment. Blinded procedure One group will receive placebo or no treatment to compare the effect of intervention. Outcomes should be measurable in numerical terms Standardised procedures to be used to ensure identical treatment for both groups except the study variable.
  5. 5. LEVEL OF EVIDENCES A1 meta-analyses (systematic reviews), which include at least some randomized clinical trials at quality level A2 that show consistent results across studies; A2 randomized clinical trials of good methodological quality (randomized double-blind controlled studies) with sufficient power and consistency; B randomized clinical trials of moderate methodological quality or with insufficient power, or other non-randomized, cohort or patient-control group study designs that involve inter-group comparisons; C patient series; D expert opinion.
  6. 6. TOTAL NO OF SUBJECTS – 18Experimental group Control group 7 females and 2 males  8 females and 1 male Mean age 58.2±8.07  Mean age 57.6±8.02 All are non-smokers  All patients have grade 2 diabetic foot ulcer (university of Texas classification) Mean ulcer duration - 45±6.7 days BMI - 23.44±3.7
  7. 7. CRITERIA TO PARTICIPATE No history of deep vein thrombosis No hemorrhage in ulcer excluded if Significant loss of protective sensation (SW 10 g monofilament and biothesiometer)
  8. 8. PROCEDURES A brief questionnaire to obtain each subject’s medical history. Subjects were questioned regarding the history of their disease, type of diabetes, duration of diabetes, and site of ulcer. Patients were randomly assigned through a computerized randomization schedule to either an experimental or a control group. To avoid bias, a technician blinded to the group allocation performed all tracings and area determinations in both pre treatment and post treatment stages.
  9. 9. ULCER SURFACE AREAMEASUREMENTDone by point grid overlays A= P X A(p)Where, A= surface area P= No of test points A(p)= area associated with one point in the grid {0.25cm2}
  10. 10. INTERVENTION• VCT 1 hour a day, 4 times a week, for 10 sessions (a total of 12 sessions during 3 weeks; the first and last sessions were considered for evaluation only).• Treatment was performed with the following parameters: –0.10 bar (–75 mmHg) of negative pressure for 60 s, followed by 0.05 bar (38.5 mmHg) of positive pressure for 30 s. Importantly, the positive pressure of 38.5 mmHg is the minimum pressure.• The control group received only the conventional therapy, which included debridement,blood glucose control agents, systemic antibiotics,wound cleaning with normal saline, offloading (pressure relief), and daily wound dressings.• All patients were instructed to use an ankle-foot cast splint for pressure redistribution at all times during ambulation.
  11. 11. RESULTS The interventions decreased foot ulcer surface areas from 46.88 ± 9.28 mm2 to 35.09 ± 4.09 mm2 in the experimental group (p = 0.006) and from 46.62 ± 10.03 mm2 to 42.89 ± 8.1 mm2 in the control group (p = 0.01). Mean surface area reduced from 46.88 ± 9.28 mm2 to 35.09 ± 4.09 mm2 in experimental and in control groups from 46.62 ± 10.03 mm2 to 42.89 ± 8.1 mm2. (p=0.024) Subject age was not significantly correlated with improvement ratio in either the experimental (p = 0.80) or control group (p = 0.42).
  12. 12. DISCUSSIONo Any factor that improves blood flow in the limb helps repair the ulcer.o Researchers believe that VCT systems do improve total tissue blood flow and oxygenation.o These systems increase periwound perfusion and consequently accelerate wound healing by producing alternating positive and negative pressure.o Unlike other physiotherapy modalities, the Vasotrain-447 can apply both positive and negative pressure, with cycles of vacuum and subsequent compression to increase capillary filling.
  13. 13. CONCLUSIONFor wound healing and limb preservation, the authors recommend VCT, in addition to conventional therapy, for patients with diabetic foot ulcers and nonhealing wounds.
  14. 14. CRITICAL APPRAISAL The first RCT in this regard which laid the foundation for future studies. The minimal usage of positive pressure make its application safer Duration of diabetes has not taken in to consideration. Ulcer measurement by point- grid overlay method focus only on surface area . Long duration of treatment. Lack of inclusion of any physiotherapeutic intervention in the control group to emphasis use of VCT over another. Lack of follow up study to confirm the longevity of effects.
  15. 15. Vacuum-Compression Therapy for the Treatment of an Ischemic Ulcer McCulloch JM Jr,Kemper CC. Phys Ther. 1993; 73: 165-1 69.1 CASE REPORT –level C evidence
  16. 16. CASE HISTORY OF SUBJECT A 30-year-old woman with a history of hyperlipidemia and severe arteriosclerosis. She was a cigarette smoker and had smoked 11/2packs per day for the previous 15 years. Physical examination revealed strong femoral pulses and weak popliteal pulses bilaterally. Dorsalis pedis and posterior tibial artery pulses were not palpable bilaterally.
  17. 17.  A right popliteal artery embolectomy was performed along with a medial calf fasciotomy. The patient was discharged on the 12th postoperative day with instructions to continue dressing. After four days of discharge ,examination reveals poor wound healing and hence started with anti-biotic therapy. At the time of discharge, the wound had begun to demonstrate the presence of a moderate amount of granulation tissue. The patient was again instructed in home wound care. One month later,the wound measured 7x 18 cm. One week after readmission, the fasciotomy site was covered with a split-thickness skin graft in an attempt to accelerate wound healing.
  18. 18.  By the 12th postoperative day, the attending surgeon judged that only 40% of the graft remained viable. One week following the second hospital stay, the patient was seen by the physical therapist and the wound measured 3 X 15.5 cm (46.5 cm2) Hydrocolloid dressingss were begun in an effort to promote autolytic debridement of the necrotic tissue Whirlpool treatments for 20 minutes thrice a week started. Following 2 weeks of physical therapy management three times per week, the wound began to lose its necrotic appearance. It still demonstrated hypogranulation, however, and its size was unchanged.
  19. 19. At this time, vacuum-compressiontherapy was started with Vasotrain 447. Following whirlpool treatment the patients left lower extremity was placed in the Vasotrain 447 and the device was set to deliver -0.10 bar (-75 mm Hg) of negative pressure for 90 seconds followed by 0.05 bar (38.5 mm Hg) of positive pressure for 30 seconds.
  20. 20.  After 2 weeks of treatment with VCT added, the wound had decreased in size by 25% and was healing at a rate of 0.59 cm2 per day. By the end of the fourth week of treatment, several 0.5 x2-cm wounds remained. All wounds were completely epithelialized by the end of the eighth week. Overall, the wound healed at a mean rate of 0.58 cm2 per day. During the next 2 months, the wound continued to remodel.
  21. 21. DISCUSSION Vacuumcompression therapy appears to have been the factor most responsible for facilitating healing in this case. A passive hyperemia that we commonly visualized within 60 seconds during treatment and that theoretically results in better capillary filling.
  22. 22. CRITICAL APPRAISAL Appears to be the first trial to assess the efficacy of VCT in wound healing. Included smoking subject. Study design not clear. No control subject to strengthen the author’s view. Possibilities of late effect of other procedures(like hydrocolloid dressings) in healing. Conventional modalities like low-level laser has not been administered to emphasis the only requirement of VCT. Lack of objective finding to conclude the capillary filling will increase with VCT.
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