VAC DRESSINGS 09-01

JOURNAL CLUB PRESENTATION: VACUUM ASSISTED CLOSURE:

JOURNAL CLUB PRESENTATION: VACUUM ASSISTED CLOSURE 17 September 2001 Tru Ngo

BACKGROUND:

BACKGROUND Wound management is a challenge in medicine VAC therapy has been used for treatment of ulcers (chronic, acute, traumatic, subacute, diabetic, pressure ulcers), flaps and grafts Chronic wounds require significant medical, nursing and financial input with poor long term results Is vacuum-assisted closure more effective than conventional dressings in treating chronic non-healing wounds?

SEARCH STRATEGY:

SEARCH STRATEGY Medline Ovid search 1995-2001 No.of articles - vacuum assisted closure 29 - topical negative pressure 5 - subatmospheric pressure therapy 0 - vacuum sealing 23 - vacuum assisted wound closure 6 - vacuum compression 16 - vacuum pack 6 Sales representative

“A Prospective Randomised Trial of Vacuum-Assisted Versus Standard Therapy of Chronic Nonhealing Wounds”:

“A Prospective Randomised Trial of Vacuum-Assisted Versus Standard Therapy of Chronic Nonhealing Wounds” Joseph E, Hamori CA, Bergman S, Roaf E, Swann NF, Anastasi GW Wounds 2000;12(3):60-67

Methods:

Methods Randomised single blinded controlled study Chronic wound types - pressure, dehiscence, trauma, venous stasis or radiation 24 patients - 12 males and 12 females 12 patients had multiple wounds Total no. of wounds - 36 3 of 12 patients with multiple wounds were randomised to both therapies

Methods:

Methods Both groups received standard nutritional supplements including zinc and multivitamins Both groups received pressure relieving surfaces Frequent examination for healing and signs of infection Biopsy for histology and culture Follow up at 3 and 6 weeks

Study Inclusion Criteria:

Study Inclusion Criteria Any patient with an open wound that had failed to close or show signs of healing within 4 weeks or greater

Study Exclusion criteria:

Study Exclusion criteria Infection (urinary tract, pneumonia, wound infection) Albumin <3.0g/dl Renal, pulmonary or other chronic disease requiring treatment, uncontrolled diabetes, thyroid disease or hypertension Systemic steroids, other immunosuppresive therapy or anticoagulants Pregnant or breast feeding

Study Exclusion Criteria:

Study Exclusion Criteria Osteomyelitis (determined by bone biopsy) Considered uncooperative or unsuitable candidates for participating in dressing changes by investigators Malignant/ neoplastic diseases in wound margin Fistulas (rectal, stomal or urethral fistulas to the wound)

Vacuum-assisted closure (VAC) vs Wet-to-moist saline dressings (WM):

Vacuum-assisted closure (VAC) vs Wet-to-moist saline dressings (WM) VAC Mean age 56 66% males Initial wound volumes 38cc Both groups comparable for ethnicity, smoking status and wound duration WM Mean age 49 44% males Initial wound volumes 24cc

Care Setting:

Care Setting Hospital n=5 Nursing home n=9 Home n=10

CHRONIC WOUND TYPES:

CHRONIC WOUND TYPES Pressure 79% (n=28) Dehiscence 8% (n=3) Trauma 5% (n=2) Venous insufficiency 5% (n=2) Radiation 3% (n=1)

VAC:

VAC 18 wounds Open-cell foam dressing with continuous suction (125mmHg) Changed every 48 hours

WM:

WM 18 wounds Normal saline wet-to-moist gauze dressings with occlusive covering used to secure gauze changed three times a day

RESULTS:

RESULTS % change in wound volume over time (using volume displacement of alginate impression molds) - 78% reduction with VAC vs 30% reduction with saline gauze dressings at 6 weeks (p=0.038)

Results:

Results Histologically WM- 81% (n=13) displayed inflammation and fibrosis VAC- 64% (n=9) showed granulation tissue formation

Results:

Results Follow up beyond the 6 weeks study period was done until complete wound closure was demonstrated for each patient All were offered operative wound closure for any remaining open wounds

Change in depth over time (weeks) p=0.00001:

Change in depth over time (weeks) p=0.00001

Change in width over time (weeks) p=0.02:

Change in width over time (weeks) p=0.02

Change in length over time (weeks) p=0.38:

Change in length over time (weeks) p=0.38

Change in volume over time (weeks) p=0.038:

Change in volume over time (weeks) p=0.038

COMPLICATIONS- VAC vs WM :

COMPLICATIONS- VAC vs WM Fistulas 0 Wound infection 0 Osteomyelitis 1 Calcaneal fractures 2 Total 3 2 6 2 0 10

DISCUSSION:

DISCUSSION Prospective Randomised Controlled Outcome assessors were blinded

Discussion:

Discussion Small sample size Withdrawals? Partially funded by KCI Neither patient or provider were blind to the treatment used Time to complete healing data was not reported

Discussion:

Discussion Cost, quality of life, pain or comfort Optimum VAC regimen for dressing type, degree of suction, continuous vs intermittent suction, duration of suction