VAC therapy for wound management in patients with contraindications to surgical treatment

Instillation Negative Pressure Wound Therapy: An Effective Tool for Complex Spine Wounds

Objective: Infection prevention in spinal surgeries involving implantation of hardware is of utmost priority. Furthermore, successful eradication of infection in hardware salvage is likewise critical in maintaining the long-term retention of the spinal hardware construct. Approach: We report a retrospective case series of three cases where the utilization of a VAC with instillation (VACi) in conjunction with surgical debridement aided in infection control and eradication for both preimplantation and hardware salvage spine patients. Results: Three patients were included. In case 1, VACi was utilized in conjunction with surgical debridement and IV antibiotics in the setting of acute preoperative infection to eradicate infection and enable necessary spinal hardware implementation. Cases 2 and 3 are representative of VACi for salvage of exposed spinal hardware in both the early and delayed infection presentation settings. In both cases, patients developed postoperative infections following spinal instrumentation VACi was utilized in conjunction with surgical debridement and IV antibiotics. Hardware removal was avoided in both cases. All three patients healed completely without residual evidence of infection. Innovation: VACi showed its effectiveness in timely infection eradication before spinal hardware instrumentation and with postoperative spine hardware salvage. Conclusion: This case series demonstrates that VACi can provide infection eradication both preoperatively in high-risk surgical sites, facilitating necessary hardware implementation and postoperatively in situations of hardware salvage.

Sequential therapy with "vacuum sealing drainage-artificial dermis implantation-thin partial thickness skin grafting" for deep and infected wound surfaces in children

OBJECTIVE

To evaluate the efficacy of a "vacuum sealing drainage (VSD) - artificial dermis implantation (ADI) - thin partial thickness skin grafting (TSG)" sequential therapy for deep and infected wounds in children.

MATERIALS AND METHODS

Fifty-three pediatric patients with deep and infected wounds were treated with sequential VSD-ADI-TSG therapy. The efficacy of this treatment was compared with that of the surgical debridement-change dressings-thin partial thickness skin grafting previously performed on 20 patients. Survival of tissue grafts, color and flexibility, subcutaneous fullness and scar formation of the graft site were examined and compared.

RESULTS

The sequential therapy combined the advantages of the VSD treatment, in reducing tissue necrosis and infection on the wound surfaces and promoting the growth of granulation tissue, with the enhancement of grafting by artificial dermis. Compared with the 20 controls, skin grafted on the artificial dermis was more smooth and glossy, while the textures of the region were more elastic, and the scars were significantly lighter in Vancouver scale.

CONCLUSION

The sequential VSD-ADI-TSG therapy is a simple and effective treatment for children with deep and infected wounds.

LEVEL OF EVIDENCE

IV.

Free dermatoplasty combined with vacuum sealing drainage for the treatment of large-area soft tissue defects accompanied by bone exposure in the lower leg

The aim of this study was to investigate the clinical efficacy of free dermatoplasty combined with vacuum sealing drainage (VSD) for the treatment of large-area soft tissue defects accompanied by bone exposure in the lower leg (crus). Free dermatoplasty combined with VSD was used to treat 36 patients with large-area soft tissue defects accompanied by bone exposure in the lower leg. The areas of the soft tissue defects ranged from 25×12 to 35×30 cm and the areas of exposed bone ranged from 6×4 to 10×6 cm. When evaluated by the open fracture Gustilo classification, 14 cases were of Gustilo type IIIA and 22 cases were of type IIIB. During surgery, adjacent available muscle flaps were transferred to cover the outer areas of the exposed bone and reduce the bone exposure range. Following VSD treatment, granulation tissues grew well and free dermatoplasty combined with VSD was used to treat and repair the wound surfaces. The patients were followed up for 1–5 years (mean duration, 2.5 years). All 36 cases with skin flap grafts survived, the free skin graft texture on the wound surface was good, the recovery of lower limb function was satisfactory and the success rate was 80.56%. Free dermatoplasty combined with VSD used for the treatment of large-area soft tissue defects accompanied by bone exposure in the lower leg may eliminate the need for amputation and complex surgery, and is a simple, fast and effective treatment method.

Clinical evidences, personal experiences, recent applications

Management of difficult wounds can be a complex, challenging and expensive task, especially for wounds showing a slow healing process. Topical negative pressure (TNP) therapy has greatly improved difficult wounds treatment. It allows to treat patient on an outpatient management, to reduce the complication rate with shorter hospital stay, to avoid frequent dressings with expensive advanced materials and allow a lower commitment of health professionals. Vacuum Assisted Closure^® (VAC^®) system is a therapeutic device based on the administration of a controlled TNP introduced by Morykwas and Argenta in 1997. It is indicated in different kinds of wound, but clinical evidences are present only for few of them. In this work we summarize indications and recommendations for VAC^® therapy and we analyze the actual better choice of treatment based on evidences and personal experience in order to stimulate further studies. Finally we introduce recent applications of VAC^® system such as Prevena^®, VAC Instill^® and VAC Via^®. Prevena^® is a system based on TNP indicated in the management of closed wounds that present risk factors for dehiscence. VAC Instill^® is a system that allows to associate TNP and topical administration of solutions, such as antibiotics or disinfectants, to treat specific type of wounds. VAC Via^® is a device based on TNP, characterized by little dimension and a preset system that allow the treatment of little wounds for 7 d, with no impairment for the patient. The aim of our paper is to describe a report of VAC^® therapy use in order to stimulate further studies and to define the level of evidence of VAC^® therapy.