The Efficacy of Topical Negative Pressure in the Management of Infected and Non-infected Wounds
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Abstract: This study evaluates the efficacy of a vacuum-assisted closure (V.A.C.® Therapy, KCI, San Antonio, Tex) device in the comparative management of clean and infected wounds. Vacuum-assisted closure was applied to 57 wounds of 51 patients. Methods. Our protocol consisted of debridement of all necrotic tissue followed by vacuum-assisted closure therapy along with appropriate antibiotic administration. In 5 cases with peripheral circulation impairment, vacuum-assisted closure therapy was terminated due to a poor tissue response. In the remaining 52 wounds, healthy granulation tissue generation was observed. Wound cultures obtained from these patients prior to the start of vacuum-assisted closure proved the presence of infection in 31 wounds, while the other 21 wounds were free of infection. Results. The average sizes of the infected and non-infected wounds were 55.77 cm2 and 57.94 cm2 prior to the start of vacuum-assisted closure, respectively, while they were reduced to 48.28 cm2 and 45.70 cm2 after the last session. At the conclusion of vacuum-assisted closure therapy, 42 wounds were skin grafted and 10 wounds were covered with skin/muscle flaps. Conclusion. Vacuum-assisted closure therapy is a reliable tool in the management of almost any type of wound, whether infected or not infected, unless major circulatory impairment interferes and acted as a contributory factor in wound formation.
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Alper Sari, MD
Phone: 903 243 37 4300
Clinical trials regarding the beneficial effects of controlled negative pressure on wound healing were initially reported in Russian journals in the mid-1980s, then in German and French journals in 1996, and later in English journals in 1997.1–9 Since its first application as an alternative to conservative wound management modalities, the indication spectrum of topical negative pressure application has grown tremendously.10 At first, it was indicated for enhancing healing of nonhealing chronic wounds, but later it was proven effective in the management of a variety of different wound scenarios, such as acute wounds, exposed surgical hardware, skin graft take, and as an aid in the survival of muscle flaps.10,11
We have been using topical negative pressure therapy in the management of both acute and chronic wounds since November 2004. The present study evaluates the effectiveness of this unique wound management modality in the management of clean and infected wounds.
Material and Methods
Patients who presented to the authors’ clinic between November 2004 and December 2007 with either clean or infected wounds and were treated with topical negative pressure therapy with the vacuum-assisted closure device (V.A.C.® Therapy, KCI, San Antonio, Tex), were included in the study.
Initially, the localization and etiology of the wounds were documented. The wound beds and the type of tissue covering the wound beds were evaluated. The presence or absence of granulation tissue and necrotic components were also recorded. The wound beds were further inspected for the presence of any exposed anatomic structures, such as tendon and/or bone, or the presence of an exposed alloplastic material. The presence of exudation and perilesional erythema were considered signs of inflammation or infection.
The surface area of each wound was measured with a digital wound area measurement device (Visitrak®, Smith and Nephew, London, UK) before and after vacuum-assisted closure therapy was completed.
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