Presented by Guide:

BINUJA S.S. PRASANTH M.S

CONTENTS INTRODUCTION

MECHANISM OF WOUND HEALING

NOVEL CONCEPTS IN WOUND HEALING

VACUUM ASSISSTED CLOSURE WOUND THERAPY

MECHANISM OF ACTION OF VAC

METHODOLOGY

USES OF VAC

ADVANTAGES AND DISADVANTAGES

APPLICATIONS

FUTURE DEVELPOMENT

CONCLUSION

REFERENCES

INTRODUCTION

Wounds may result from trauma or from a surgical incision. In

addition, pressure ulcers (also known as decubitus ulcers or bed

sores), a type of skin ulcer, might also be considered wounds.

Wound healing is the process of repair that follows injury to the

skin and other soft tissues.

The capacity of a wound to heal depends in part on its depth,

as well as on the overall health and nutritional status of the

individual.

Following injury, an inflammatory response occurs and the

cells below the dermis (the deepest skin layer) begin to increase

collagen (connective tissue) production. Later, the epithelial

tissue (the outer skin layer) is regenerated.

Standard wound management consists of:

Initial surgical debridement (a rapid and effective technique to remove devitalised tissue).

Wet-to moist (WM) gauze dressings , which need to be changed at least twice daily.

These dressings are relatively inexpensive, readily available.

Disadvantages: non-selective debridement with dressing removal, possible wound desiccation, and the need for frequent dressing changes.

The vacuum-assisted closure (VAC) device was pioneered by Dr Louis Argenta and Dr Michael Morykwas in 1993.

Vacuum-assisted closure (VAC) therapy-

Alternative to the standard forms of wound management, which incorporates the use of negative pressure to optimise conditions for wound healing and requires fewer painful dressing changes.

MECHANISM OF WOUND HEALING

NOVEL CONCEPTS IN WOUND HEALINGWound dressing

Dry dressing

Wet-to-dry dressing

Foam dressing

Alginate dressing

Hydro-fibre dresssing

Transparent film dressings

Hydrogel dressing

Hydrocolloid dressing

VACUUM ASSISSTED CLOSURE WOUND THERAPY The application of controlled levels of negative

pressure accelerates debridement and promote healing in many different types of wounds.

The optimum level of negative pressure appears to be around 125 mmHg.

Negative pressure assists;

Removal of interstitial fluid.

Decreases localised oedema.

Increases blood flow.

MECHANISM OF ACTION Promotes granulation tissue

formation . Stimulates localized blood

flow .

Reduces bacterial colonization

Provides moist wound healing environment

Reduces localized edema

Enhances epithelial migration

Applies negative pressure to uniformly draw wound closed (wound contraction)

VAC SYSTEM

VAC PUMP

SPONGEPolyurethane Foam Poly-vinyl-alcohol

Pore size:400-600 microns Pore size: 0.2 -1mm

Tube

For fluid For measurement

Multi-lumen

METHODOLOGYMaterials needed: Scissors (sterile or clean) Gloves (sterile or clean) Dressing kit Canister V.A.C. UnitOptional: Skin prep Tincture Benzoin Non-adherent dressing, such as Mepitel

Aggressively clean wound

Debride necrotic tissue or eschar if possible

Achieve hemostasis

Shave hair around border if needed

Irrigate wound with normal saline

Dry and prep skin as appropriate

Cut foam to size of wound

Gently lay foam in wound, including tunnels,

undermining, and all surfaces

1.Clean wound thoroughly

Aggressive cleaning of the wound at each dressing change is

imperative to decrease bacterial load and minimize odor

Cut foam

Cut the foam to fit the size and shape of the wound, including tunnels and

undermined areas

Lay foam in wound

Gently place the foam into the wound cavity, covering the entire

wound base and sides, tunneling and undermining

Cut the drape

Cut the drape large enough to cover the foam and 3-5 cm of surrounding

healthy tissue with drape.

Applying the drape

Apply the drape beginning on one side of the foam, toward the tubing. Do not

stretch the drape and do not compress the foam into the wound with drape.

This helps minimize tension or shearing forces on periwound tissue

Applying the suction tubing

Cut hole in drape about 1.5 cm and apply tubing

Connect to canister

Connect dressing tubing to canister tubing, making sure clamps are open

Y - connecting

A Y-connector is available to connect 2 or more wounds to one V.A.C. pump

Canister CANISTER WITH ISOLYSER

Canister comes with Isolyser gel that gels fluid on contact and helps

eliminate odor

USES OF VAC THRAPY1. Acute Surgical Wounds

2. Pressure Ulcers

3. Diabetic Wounds

4. Open Abdominal Wounds

ADVANTAGESProvides more effective therapy because target sub

atmospheric pressure is monitored and maintained at Maximizes accuracy and effectiveness of V.A.C.® Therapy.

Reduced frequency of dressing changes.

Reduced bacterial cell count.

Enhanced dermal perfusion.

Provision of closed, moist wound healing environment.control of odour and exudate.

Reduction in complexity and number of surgical procedure.

DISADVANTAGES Pain and discomfort when suction is applied initially.

Allergies to adhesive drape.

Noise of vac therapy unit.

If the wound deteriorates after the first dressing change discontinue vac therapy.

Fulminant or incipient skin necrosis.

Excoriation of the skin if foam is not correctly cut to use.

Drain require fixation.

APPLICATIONS

Treatment of early hip joint infections.

Post operative ascetic fluid leaks in cirrhotic patients.

Wound temporation in composite scalp and calvarial

defects.

Sea water-immersed wound treatment under different

negative pressure.

Treatment of perineal war wound related to rectum.

In patients with wound dehiscence after abdominal

open surgery.

Management of Postpneumonectomy Empyema.

Management of lung abscess.

Treatment of mastitis assossiated chronic breast

wounds.

FUTURE DEVELOPMENT Emerging use of VAC therapy in the paediatric

population. Clarification is needed on the type of foam dressing and pressure settings to be used in these patients.

Research is needed to establish the relationship between negative pressure and blood flow and the optimal pressure for wound healing.

As new negative pressure devices are developed, there will be a need to compare the effectiveness of the V.A.C. Therapy system with these emerging systems.

CONCLUSION New tool.

Convert complicated wound into simpler wound.

Improved efficacy

Safety outcomes

Limited cost effectiveness

Fewer painful dressing changes

Smoother transition from hospital to community

REFERENCE Sziklavari Z, Grosser C, Neu R, Schemm R, Kortner A,(

2011) “Complex pleural empyema can be safely treated with vacuum-assisted closure." Cardiothorac Surgery, 6-130.

Labler L, Keel M, Trentz O. (2004) Vacuum-assisted closure (V.A.C.) for temporary coverage of soft-tissue injury in type III open fracture of lower extremities. European Journal of Trauma ; 30(5):305-12.

Hunter JE, Teot L, Horch R, Banwell PE (2007). Evidence based medicine: vacuum assisted closure in wound care management. Wound J ; 4(3): 256-69.

M. J. Morykwas, J. Simpson, K. Punger, A. Argenta, L. Kremers, and J. Argenta,(2006) “Vacuum-assisted closure: state of basic research and physiologic foundation,” Plastic and Reconstructive Surgery, vol. 117, no. 7, pp. 121S–126S.

Palmen M, van Breugel HN, Geskes GG, (1997). Open window thoracostomy treatment of empyema is accelerated by vacuum-assisted closure. Ann ThoracSurg;88:1131-6.