This study evaluated the effect of vacuum-assisted closure (VAC) therapy on wound management outcomes for patients undergoing reconstruction with split-thickness skin grafts. The study involved 100 patients randomized to either a VAC therapy group or control group treated with normal saline dressings. Results showed significantly better outcomes for the VAC therapy group, including greater graft take (>95% for 90% of patients), shorter wound healing time (2 weeks for 90% of patients), no need for re-grafting, and shorter hospital stays (<3 weeks for 90% of patients). The study concluded that VAC therapy improves wound bed preparation and is advantageous compared to traditional dressings when reconstructing wounds with skin grafts.
Negative Pressure Wound Therapy also widely known as NPWT, WOUND VAC or TNP(Tropical Negative Pressure) is a widely accepted advanced wound management modality today
Vacuum Assisted Closure (VAC): A Promising Therapeutic Tool for Enterocutaneo...KETAN VAGHOLKAR
Managing an enterocutaneous fistula continues to pose the greatest challenge to the general surgeon. Aggressive supportive care is pivotal in managing these patients. Vacuum assisted closure (VAC) therapy is a promising therapeutic tool for such patients. It undoubtedly helps in closure of the fistula thus avoiding the high morbidity and mortality associated with surgical intervention. A case of a complex enterocutaneous fistula treated by VAC therapy is presented.
Negative pressure wound therapy: A promising weapon in the therapeutic wound ...KETAN VAGHOLKAR
Negative pressure wound therapy or vacuum assisted wound therapy is an excellent therapeutic option for chronic wounds which are just refusing to heal. The principles and practical applications of this optio are discussed in the article.
Our new programmable CCNPWT system delivers controlled negative pressure in the wound site to accelerate healing process. The system delivers continuous, variable and intermittent therapy settings for effective therapy goals. The fully loaded system with safety parameters for leakage, blockage, canister full and system inactive conditions. The robust system has been designed light just about 950gms for mobile patients with a very user friendly operation menu.
Negative Pressure Wound Therapy also widely known as NPWT, WOUND VAC or TNP(Tropical Negative Pressure) is a widely accepted advanced wound management modality today
Vacuum Assisted Closure (VAC): A Promising Therapeutic Tool for Enterocutaneo...KETAN VAGHOLKAR
Managing an enterocutaneous fistula continues to pose the greatest challenge to the general surgeon. Aggressive supportive care is pivotal in managing these patients. Vacuum assisted closure (VAC) therapy is a promising therapeutic tool for such patients. It undoubtedly helps in closure of the fistula thus avoiding the high morbidity and mortality associated with surgical intervention. A case of a complex enterocutaneous fistula treated by VAC therapy is presented.
Negative pressure wound therapy: A promising weapon in the therapeutic wound ...KETAN VAGHOLKAR
Negative pressure wound therapy or vacuum assisted wound therapy is an excellent therapeutic option for chronic wounds which are just refusing to heal. The principles and practical applications of this optio are discussed in the article.
Our new programmable CCNPWT system delivers controlled negative pressure in the wound site to accelerate healing process. The system delivers continuous, variable and intermittent therapy settings for effective therapy goals. The fully loaded system with safety parameters for leakage, blockage, canister full and system inactive conditions. The robust system has been designed light just about 950gms for mobile patients with a very user friendly operation menu.
Content server (10)A randomized, controlled, double-blind prospective trial w...Missing Man
A randomized, controlled, double-blind prospective trial
with a Lipido-Colloid Technology-Nano-OligoSaccharide
Factor wound dressing in the local management of
venous leg ulcers
Despite the routine use of prophylactic systemic antibiotics, surgical-site infection continues to be associated with significant morbidity and cost after colorectal sur- gery. The gentamicin–collagen sponge, an implantable topical antibiotic agent, is approved for surgical implantation in 54 countries. Since 1985, more than 1 million patients have been treated with the sponges.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay
Despitetheroutineuseofprophylacticsystemicantibiotics,sternalwoundin- fection still occurs in 5% or more of cardiac surgical patients and is associated with signifi- cant excess morbidity, mortality, and cost. The gentamicin-collagen sponge, a surgically implantable topical antibiotic, is currently approved in 54 countries. A large, 2-center, ran- domized trial in Sweden reported in 2005 that the sponge reduced surgical site infection by 50% in cardiac patients.
EVALUATION OF ABSORBABLE AND NON-ABSORBABLE SUTURES IN A COHORT STUDYAnil Haripriya
Suturing has been used all the way through the ages to assist healing of human tissues by wound closure. Earlier, animal fibers were used as thread and the needles were fashioned from animal bone or bits of metal. Nowadays, sterilized sutures have mostly replaced these materials but the essential principles remain the same.[13]
Impact of dead space closure and lymph vessel ligation during MRM on Post-ope...Dr./ Ihab Samy
Hany F. Habashy MD.a , Ihab S. Fayek MD b , Mohamed I.Abd el aziz MD a
a:Department of Surgery-Fayoum University Hospital-El Fayoum , Egypt.
b:Department of Surgical Oncology –National Cancer Institute – Cairo University ,Egypt.
Kasr el-aini journal of surgery Volume 14, No.2, May 2013
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Vacuum-assisted closure therapy
1. Journal of the College of Physicians and Surgeons Pakistan 2010, Vol. 20 (10): 675-679 675
INTRODUCTION
Wound has been a formidable foe for healers since
antiquity. The general principles of wound management,
entailing debridement and repeated dressings have
been established since ancient times. The key objective
of wound management is to achieve early complete
healing. Delay in healing predisposes to infection and
poses protracted morbidity. Direct closure of wound is
the most efficient way of achieving healing, however,
only clean wounds without much tissue loss are
amenable to it e.g. clean surgical wounds. In complex
wounds with tissue loss, healing can be promoted
by secondary intention or reconstruction with grafts
and flaps.1-3
VAC therapy has been reported very useful in the
treatment of both acute and chronic wounds. In 1993
Fleischmann et al. from Germany were the first to report
successful use of this technique in 15 patients with open
fractures.4 Argenta et al. from the US in 1997 pioneered
further clinical research that lead to popularity of VAC
therapy across a range of specialties.5
Since VAC therapy is a relatively novel addition to the
wound care armamentarium, its exact mechanism of
action still continues to be researched. It has been
shown to increase wound blood flow, granulation tissue
formation, and decreases edema fluid and bacteria at
the wounded site.5,6
The present study was undertaken to evaluate the effect
of VAC therapy on wound management outcomes in
patients undergoing reconstruction with STSG.
METHODOLOGY
The study was carried out at the Department of Plastic
Surgery, PIMS, Islamabad, from October 2007 to
December 2009. It included a total of 100 adult patients
of either gender aged over 13 years, having different
ABSTRACT
Objective: To evaluate the effect of vacuum-assisted closure (VAC) therapy on wound management by measuring the graft
take, wound healing time, need for any re-grafting and duration of hospitalization.
Study Design: Single blinded randomized controlled trial.
Place and Duration of Study: This study was carried out in the Department of Plastic and Reconstructive Surgery,
Pakistan Institute of Medical Sciences (PIMS), Islamabad, from October 2007 to December 2009.
Methodology: A total of 100 adult patients of either gender with acute traumatic wounds were included. Patients who
needed flap coverage as the primary intervention, and those with Diabetes, malignancy, bleeding diathesis were excluded.
Half of the patients were randomly assigned to the intervention group and the rest to the control group with lottery method.
All wounds were initially subjected to thorough excision. Wound bed preparation for STSG (split thickness skin graft) was
achieved using 10 days pre-treatment with VAC dressings in the intervention group while employing normal saline gauzes
in the control group. All patients were subsequently treated with STSG. The primary outcome measure was graft take while
the secondary outcome measures included wound healing time, need for any re-grafting and duration of hospital stay.
Results were compared in both groups using chi-square test.
Results: Marked differences were found in favour of the VAC therapy group with respect to the various wound
management outcome measures studied. i.e. graft take (greater than 95% graft take in 90% of VAC therapy group vs. 18%
of controls), wound healing time (2 weeks postgrafting in 90% of VAC therapy group vs. 18% of controls), need for re-
grafting (none among VAC therapy group vs. 8% of controls) and duration of hospital stay (less than 3 weeks in 90% of
VAC therapy group vs. 18% of controls).
Conclusion: VAC therapy should be employed in the pre-treatment of wounds planned to be reconstructed with STSG,
since it has marked advantages in the wound bed preparation compared with the traditional normal saline gauze
dressings.
Key words: Open wound. Wound bed preparation. Vacuum assisted closure therapy. Vacuum-assisted closure dressing.
Split thickness skin graft. Graft take.
Department of Plastic Surgery, Pakistan Institute of Medical
Sciences (PIMS), Islamabad.
Correspondence: Dr. Muhammad Saaiq, Room No. 20, MOs
Hostel, Pakistan Institute of Medical Sciences (PIMS),
Islamabad.
E-mail: muhammadsaaiq5@gmail.com
Received January 08, 2010; accepted August 11, 2010.
Vacuum-Assisted Closure Therapy as A Pretreatment For Split
Thickness Skin Grafts
Muhammad Saaiq, Hameed-ud-Din, Muhammad Ibrahim Khan and Saud Majid Chaudhery
ORIGINAL ARTICLE
2. acute traumatic wounds (of a duration of up to 06
weeks) measuring ≥ 9 cm2 surface area. Patients who
needed flap coverage as the primary intervention, and
those with either Diabetes, malignancy or bleeding
diathesis were excluded. Informed consent was taken
from all the patients for participation in the study and be
randomized to either intervention or control group
without being aware of it. Initial assessment and
diagnosis was made by history, physical examination
and necessary investigations.
Half of the patients were randomized to the intervention
group (those whose wounds were pre-treated with VAC
therapy before STSG) and half to the control group
(whose wounds were pre-treated with daily normal
saline gauze dressings before STSG). Simple random
sampling was done with lottery method. The two groups
were matched for age, gender, and wound
characteristics including size and site of the wound.
Initially all wounds were debrided with thorough surgical
excision of devitalized tissues, and tissue sent for
bacterial culture and sensitivity tests. Before proceeding
to STSG reconstruction, the wounds were optimized
with 10 days pre-treatment, using VAC dressings in the
intervention group (two VAC dressings each maintained
for 5 days) while employing daily normal saline gauze
dressings in the control group. This pre-treatment was
continued for 10 days when STSG reconstruction was
undertaken in all culture-negative patients.
For VAC dressing, two synthetic foam sheets were
fashioned to the size and shape of the wound and
applied to cover the wound with a Redivac suction drain
(with multiple side ports) sandwiched between the two
layers. A transparent sealing plastic membrane sheet
(OpsiteTM in small wounds and plastic food wrap for
large wounds) was then applied to the foam layers,
making the system water tight and air tight. Thus the
open wound was converted into a close controlled one.
The suction drain was connected to suction machine or
wall vacuum suction maintained at 50-120 mmHg
intermittently. At the end of 5 days, VAC dressing was
removed and a fresh VAC dressing applied after
washing the wound with normal saline and undertaking
wound debridement if needed. After 10 days of VAC
therapy, STSG reconstruction was undertaken in all
culture-negative patients.
All patients underwent reconstruction with intermediate
thickness STSG (0.012–0.015 inch). All skin grafts were
meshed 1.5:1 ratio. The skin grafts were applied on the
granulating wound bed and secured in place with
staples. Non adherent sofratulle gauzes were placed
onto the skin graft prior to the application of tie over and
absorbent dressings. The dressings were left in place
until 5th postoperative. During this time, the patients
were kept on bed rest to avoid any shearing forces on
the grafted wounds. On the 5th postoperative day, the
dressings were removed and wounds assessed by
gross inspection for graft take which was measured as
the percentage of the grafted surface area where graft
was taken by wound bed. The patients were stratified
into three groups with regard to graft take: good take
where ≥ 95% graft was taken, fair take where 80-95%
wound surface had taken graft and poor take where less
than < 80% wound surface had taken graft.
Following discharge, the wound dressings were changed
every 3rd day for 10 days. Wounds were examined on
14th postoperative day of grafting for evidence of
healing with stable skin coverage and/or need for re-
grafting. Figures 1 through 4 are representative pictures
of one of the VAC treated patients.
The data were analysed through SPSS version 10 and
various descriptive statistics were used to calculate
frequencies, percentages, means and standard deviation.
The numerical data such as age, wound size and
duration of hospital stay were expressed as mean ±
standard deviation while the categorical data such as
the site of wounds, causes of wounds, and organisms
cultured were expressed as frequency and percentages.
The percentages of various outcome variables were
compared by employing chi-square test and a p-value of
less than 0.05 was regarded as statistically significant.
RESULTS
Out of a total of 100 patients, 86% (n=86) were males.
The age ranged from 13-65 years, with a mean of 33.07
± 13.60 years. Majority of the patients were in their 3rd
and 4th decades of life.
Most frequent location of the wounds was lower limb
(n=56), followed by upper limb (n=24), trunk (n= 14), and
scalp (n=6). The causes of wounds included road traffic
accidents in 72%, machine injuries in 12%, falls in 6%,
676 Journal of the College of Physicians and Surgeons Pakistan 2010, Vol. 20 (10): 675-679
Muhammad Saaiq, Hameed-ud-Din, Muhammad Ibrahim Khan and Saud Majid Chaudhery
Figure 1: Road traffic accident victim
with degloving injury right thigh.
Figure 2: VAC dressing in place after
radical debridement.
Figure 3: Wound rendered graftable
by two VAC dressings.
Figure 4: Good graft take on 5th
postoperative day.
3. firearm injuries in 4%, blast injuries in 4% and fire
crackers in 2%. Wound surface area ranged from 9 cm2
to 500 cm2. The overall mean wound surface area was
64. 58± 90.88 cm2.
The initial culture of the wounds sent at the first wound
debridement showed growth of organisms in 17
patients. The most commonly found organisms were
Staphylococcus aureus (n = 11), followed by coagulase
negative Staphylococcus (n = 2), Enterococcus faecalis (n = 2),
Pseudomonas aeruginosa (n = 1), and Escherichia coli (n = 1).
The repeat culture of these patients after 5 days
treatment with intravenous antibiotics were negative for
growth of organisms. The most frequently instituted
antibiotic was co-amoxiclave.
Greater than 95% graft take was seen in 45 (90%)
patients of the VAC group compared to only 9 (18 %) of
the control group. Table I shows the graft take as
percentage of the grafted surface area.
None of the patients in VAC group needed re-grafting,
however, 4 (8%) patients among the control group were
re-grafted for residual areas of graft failure. The
remaining patients with partial skin graft failure healed
successfully with repeated dressings, alginate dressings
and healing by secondary intention.
Duration of hospital stay was significantly shorter among
the VAC group patients (Table II). Table III depicts the
healing time observed among the patients of the two
groups.
The hospital stay was 18-35 days with a mean of 21.58
± 3.58 days. There was no in-hospital mortality.
DISCUSSION
In this study, as the inclusion criteria was open wounds
of traumatic origin, majority of the patients were young
males. Males are more frequently involved in outdoor
activities and hence more prone to sustain different
traumatic insults because of road traffic accidents, falls,
firearm injuries and blasts etc. Predominant involvement
of young males further amplifies the grave implications
of such disabling injuries. Male predominance and more
frequent involvement of younger population is well
documented in the context of trauma in general.7 With
increasing civil violence, there is an increasing number
of patients with blast injuries as well.
In this study the use of VAC therapy as pre-treatment for
skin grafts, favourably influenced the management of
open wounds. In the past, a number of adjuvant
therapies such as use of skin substitutes, growth factors
and hyperbaric oxygen etc. have been employed to
expedite wound healing. VAC therapy was found a better
alternative in this regard as it is more economical and
safer. The present findings are in conformity with those
of other published studies.8-10
In this study, VAC therapy was employed only in the
preparatory phase before skin grafting of the wounds.
Several published studies have successfully used VAC
dressings for securing skin grafts postoperatively,
especially in wounds with exudative, irregular, or mobile
recipient beds and in difficult anatomic locations. It has
been reported to stabilize the skin graft and conform it
well to the shape of recipient bed, remove edema fluid,
decrease bacterial counts, and provide a secured
dressing. All these factors further improve the graft
survival and reduce the need for repeat skin grafting.11-14
In this study healing time and hospital stay were
significantly reduced in the patients treated with VAC
therapy. Other published studies have also shown fast
healing with VAC therapy.15-17 A variety of factors have
been described to account for the accelerated healing.
VAC therapy continually decontaminates the wound and
drains the wound surface of exudates, which contain
large amounts of proteases. Those would normally
inhibit fibroblastic division, collagen production, and cell
growth. Fluid removal helps with localized edema that
otherwise causes an increase in interstitial pressure with
consequent occlusion of microvasculature and
lymphatics, decreased nutrient, and oxygen delivery.
Protein degradation enzyme is released with metabolic
waste accumulation and increased bacterial
colonization, which causes capillary damage and
hypoxia. VAC therapy also provides a moist environment
to promote granulation tissue formation and prevents
eschar formation, which allows for a smoother pathway
to re-epithelialize the wound surface. Angiogenesis is
stimulated, which improves tissue oxygenation and
tissue reconstruction. This enhanced angiogenesis
occurs even in patients with diabetic microangiopathy,
and promotes healing of distal lesions.18,19 Micro-
mechanical forces exerted on wound surface by low
Journal of the College of Physicians and Surgeons Pakistan 2010, Vol. 20 (10): 675-679 677
Vacuum-assisted closure therapy as a pretreatment for split thickness skin grafts
Table I: The take of split thichness skin graft among the patients
(n=50 each group).
S. No. Graft take % Number of patients Nnumber of patients p-value
(VAC group) (control group) (%)
1 ≥ 95% 45 (90%) 9 (18%) p < 0.001*
2 80-94% 4 (8%) 32 (64%) p < 0.001*
3 < 80% 1 (2 %) 9 (18%) 0.03*
* p-value significant = < 0.05.
Table II: The duration of hospital stay (n=50 each group).
S. No. Duration of Number of patients Number of patients p-value
hospital stay (VAC group) (control group) (%)
1 Upto 20 days 45 (90%) 9 (18%) p < 0.001*
2 21-28 days 5 (10%) 37 (74%) p < 0.001*
3 > 28 days - 4 (8%) 0.349 **
* p-value significant = < 0.05; ** = not significant.
Table III: Time to complete healing observed among the patients
(n=50 each group).
S. No Time to complete No. of patients No. of patients p-value
healing (VAC group) (control group) (%)
1 2 weeks postgrafting 45 (90%) 9 (18%) p < 0.001*
2 3-4 weeks postgrafting 3 (6%) 36 (72%) p < 0.001*
3 > 4 weeks postgrafting 2 (4 %) 5 (10%) 0.111 **
* p-value significant = < 0.05; ** = not significant.
4. pressure suction are also important. This mechanism
mimics the stretch-induced cell proliferation typically
operative in tissue expansion phenomenon seen else-
where in the body. 20,21
Owing to its low cost, VAC therapy can provide an
economical alternative to the other available costly local
wound management measures. Such economic
implications of wound management are particularly
important in the context of our poor patients. Cost
effectiveness has also been reported in terms of
shortened hospital stays, and decreased overall medical
cost in the published literature. 22,23
In this study VAC therapy was additionally found to be
more comfortable for patients as well as the surgical
staff. It obviated the need for daily dressing changes.
Similar findings have been reported by other studies as
well.22,23
This study has some limitations. It is a single centred
study. Blinding of the treating doctors was not possible
and so observer bias could not be eliminated
completely.
This study should prompt other local studies and hence
allow more meaningful comparison of results in our own
population. We recommend the conduct of a multicentre
local study to confirm and improve upon our results.
Additionally a local study may be conducted to compare
the cost of VAC therapy versus other wound preparatory
methods such as use of skin substitutes or growth
factors, and hence evolve an evidence base to confirm
VAC therapy as an economical alternative to the other
costly local wound management measures.
CONCLUSION
VAC therapy should be employed in the pre-treatment of
wounds planned to be reconstructed with STSG, given
its significant advantages in the wound bed preparation
compared with traditional normal saline gauze
dressings.
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Vacuum-assisted closure therapy as a pretreatment for split thickness skin grafts
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