VAC Therapy

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InfoVAC
InfoVAC

The Vacuum-Assisted Closure (V.A.C.®) device was developed by Louis C. Argenta, M.D., professor and chairman of the plastic and reconstructive surgery department, and Michael J. Morykwas, Ph.D., assistant professor of plastic and reconstructive surgery at Wake Forest is now being used worldwide to promote healing in large abdominal wounds, fight infection following open heart surgery and enhance healing of burns. More than a million Americans now are using the device as part of their home therapy. V.A.C. Therapy is a topical treatment intended to promote healing in acute and chronic wounds. It involves the application of negative (sub atmospheric) pressure (Negative Pressure Wound Therapy) to the wound bed applied by a tube which decompresses a foam dressing, continuously or intermittently, depending on the type of wound being treated and the clinical objectives.[1][2] Intermittent removal of used instillation fluid supports the cleaning and drainage of the wound bed and the removal of infectious material.[1] [2] [3] [4]

Contents

[edit] Mechanisms

V.A.C. Therapy consists of a foam dressing, which adapts to the contours of deep and irregularly shaped wounds. A drainage tube is placed in the dressing and an occlusive transparent film seals the wound and the drainage tube. The tube is connected to a vacuum source, which supplies the negative pressure. The concept is to turn an open wound into a controlled, closed wound while removing excess fluid from the wound bed, thus enhancing circulation and disposal of cellular waste from the lymphatic system.

[edit] KCI

In 1995 the Food and Drug Administration was presented with and first approved negative pressure equipment that was subsequently marketed as the VAC, by KCI (Kinetic Concepts, Inc).

[edit] Wounds

The technique is usually considered for chronic wounds (those that fail to progress through the normal phases of healing-inflammation, proliferation, maturation-and thus do not heal), acute wounds (wounds that are expected to heal and demonstrate evidence of progression through the phases of healing), and difficult wounds (wounds with such associated factors as diabetes, arterial insufficiency, and venous insufficiency).[5] However, KCI claim that the VAC can be used for a variety of wounds, also those that are not as severe.[3]

[edit] Diabetic Foot Wounds

In December 2007, a large multicenter randomized controlled trial was published. This trial shows a greater proportion of foot ulcers achieved complete ulcer closure with NPWT (73/169, 43.2%) than Advanced Moist Wound Therapy (48/166, 28.9%) within the 112-day Active Treatment Phase. The study also showed significantly faster wound healing, a reduced number of secondary amputations and no changes in therapy associated complications. [6]

Diabetic foot ulcer prior VAC Therapy treatment
Diabetic foot ulcer prior VAC Therapy treatment
Diabetic foot ulcer post VAC Therapy treatment
Diabetic foot ulcer post VAC Therapy treatment

[edit] Products

  • VAC ATS was designed for higher acuity wounds for patients in acute care and long-term care facilities.
  • VAC Freedom is a portable VAC unit, designed for the homecare setting.
  • VAC Instill combines VAC Therapy with the automated delivery of topical wound solutions (medicine) to wound sites.

In 2007, KCI launched the next generation VAC products:

  • ActiVAC, a light weight unit for use in the homecare setting, lighter and smaller than VAC Freedom.
  • InfoVAC, for the acute care environment, offering access to wound progress data.

[edit] Advantages

  • Provides a closed moist wound healing environment [7]
  • Decreases wound volume [8]
  • Removes excess fluids that can inhibit wound healing [9]
  • Helps remove interstitial fluid [10]
  • Promotes granulation [11]
  • Helps to decrease bacterial colonization at the wound site [12]

[edit] Appropriate applications for VAC Therapy

  • Acute wounds
  • Partial thickness burns
  • Venous or arterial insufficiency ulcer unresponsive to standard therapy
  • Traumatic wounds (i.e., flap or meshed graft)
  • Pressure ulcers
  • Diabetic ulcers
  • Chronic open wounds
  • Acute and traumatic wounds
  • Flaps and grafts
  • Dehisced wounds

[edit] See Also

[edit] External links

VAC therapy developed at Wake Forest University
Official KCI Site
Official ActiVAC Site
Official InfoVAC site

[edit] References

  1. ^ Bernstein BH, Tam H. 2005.Combination of subatmospheric pressure dressing and gravity feed antibiotic instillation in the treatment ofpost-surgical diabetic foot wound: a case series. Wounds 17 (2): 37–48
  2. ^ Fleischmann W., Russ M., Stampehl M. 1998. Die Vakuumversieglung als Trägersystem für eine gezielte lokale Medikamentenapplikation bei Wundinfektionen. Unfallchirurgie 101:649–654
  3. ^ Wolvos T. 2004. Wound instillation – the next step in negative pressure wound therapy. Lessons learned from initial experiences. Ostomy Wound Manage 50: 56–66
  4. ^ Moch D., Fleischmann W., Westhauser A. 1998. Instillation Vacuum sealing – report of initial experiences. Langenbecks Arch Chir Suppl. Kongressbd 115:1197–1199
  5. ^ BioMechanics . Michael S. Miller, DO, Rhonda Brown, LPN, and Cheryl McDaniel, LPN, Negative pressure wound therapy options promote patient care
  6. ^ Comparison of Negative Pressure Wound Therapy Utilizing Vacuum-Assisted Closure to Advanced Moist Wound Therapy in the Treatment of Diabetic Foot Ulcers A Multicenter Randomized Controlled Trial.Blume PA, Walters J, Payne W, Ayala J, Lantis J., North American Center for Limb Preservation 506 Blake Street, New Haven, CT 06515
  7. ^ Charles K. Field et al. Overview of Wound Healing in a Moist Environment. American Journal of Surgery, 1994.
  8. ^ Joseph E., Hamori CA., Bergman S., Roaf E., Swann N., Anastasi G. Prospective Randomized Trial of Vacuum-Assisted Closure versus Standard Therapy of Chronic Non-healing Wounds. Wounds, 2000; 12(3): 60–67.
  9. ^ Brian Bucalo MD, William H. Eaglestein, MD, Vincent Falanga, MD. Inhibition of Cell Proliferation by Chronic Wound Fluid. Wound Repair and Regeneration, 1993.
  10. ^ Argenta, L. C., Morykwas, M. J. Vacuum-Assisted Closure: A New Method for Wound Control and Treatment: Animal Studies and Basic Foundation. Annals of Plastic Surgery, 1997; 38(6).
  11. ^ Argenta, A., Webb K., Simpson J., Gordon S., Kortesis B., Wanner M., Kremers L., Morykwas M. Deformation of Superficial and Deep Abdominal Tissues with Application of a Controlled Vacuum. European Tissue Repair Society, Focus group meeting Topical Negative Pressure (TNP) Therapy, 4–6 December 2003, London.
  12. ^ Fleck CA, Frizzell LD. When negative is positive: a review of negative pressure wound therapy
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