Study to Analyse the Efficacy of Vacuum Assisted Closure (Vac) for Open Musculoskeletal Trauma and Wound Dehiscence (original) (raw)
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International Journal of Orthopaedics Sciences
Background: Post operative wound dehiscence is a significant health problem. In imposes social and financial burdens. If the injury involves the exposure of bone, early coverage of the defect must be a goal of treatment to prevent secondary problems such as an osteogenic infection. Vacuum-assisted closure (VAC) therapy has been developed as an 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. It is a wound management system that exposes a wound bed to local negative pressure to promote healing. This article reviews the use of VAC therapy in a post operative of wound. Material and method: A prospective study conducted in department of orthopaedic surgery, Grant medical college and sir JJ Group of hospital, Mumbai from 2016-2017. A total of 25 subjects were consecutively recruited. Patients included in study are classified according to the grade of the ulcer. Patients age group 21-70 years with the following risk factors and comorbidities diabetes mellitus, hypertension, chronic obstructive pulmonary disease, dyslipidaemia, and smoking. Post operative wound dehiscence of proximal tibia, distal tibia and olecranon selected. Pre and post VAC culture collected. Patients were evaluated post VAC after definitive management for functional outcome. Result: Our study of confirms that vacuum assisted closure is an excellent treatment modality for post operative wound dehiscence. Patients had an average of 8 treatment sessions. The duration of VAC application ranged from 12 to 36 days with an average hospital stay of 24 days. Amongst this maximum patients being in the age group of 30-70 years. VAC dressing found to produce more secondary closure of wound and split skin graft, also reduced more invasive procedures like flap surgery and in worst case amputation. Also it found reduces bacterial count of the wound. Conclusion: Promotes early rehabilitation, and alleviates the need for a second procedure. Significant reduction in hospital stay subsequent lower in hospital cost, decreased amputations, increasing the number of patients undergoing skin grafting and improving culture sterility.
Background. This study was performed to evaluate the results of vacuum assisted wound therapy in patients with open musculoskeletal injuries. Study Design and Setting. Prospective, randomized, and interventional at tertiary care hospital, from 2011 to 2012. Materials and Methods. 30 patients of open musculoskeletal injuries underwent randomized trial of vacuum assisted closure therapy versus standard wound therapy around the upper limb and lower limb. Mean patient age was 39 ± 18 years (range, 18 to 76 years). Necrotic tissues were debrided before applying VAC therapy. Dressings were changed every 3 or 4 days. For standard wound therapy, debridement followed by daily dressings was done. Data Management and Statistical Analysis. The results obtained were subjected to statistical analysis. Results. The size of soft tissue defects reduced more than 5 mm to 25 mm after VAC (mean decrease of 26.66%), whereas in standard wound therapy, reduction in wound size was less than 5 mm. A free flap was needed to cover exposed bone and tendon in one case in standard wound therapy group. No major complication occurred that was directly attributable to treatment. Conclusion. Vacuum assisted wound therapy was found to facilitate the rapid formation of healthy granulation tissue on open wounds in the upper limb and lower limb, thus to shorten healing time and minimize secondary soft tissue defect coverage procedures.
International Journal of Orthopaedics Sciences, 2019
Introduction: Wound healing is a complex, dynamic process and delayed wound healing significant health problem in India. Various type of surgical methods have been developed for wound healing such as Advanced Wound Care Therapies (AWCT)/ Vacuum-Assisted Closure (VAC) and myo-cutaneous or fascio-cutaneous tissue transfers, Stander dressing therapy etc. VAC Therapy is a Non-Invasive therapy. This therapeutic technique using for the management of large chronically infected wounds more recently used in the treatment of traumatic wounds and non-healing wounds. Aim: Aim of this study is to evaluate functional outcome of vacuum-assisted closure (VAC) dressing therapy for the management of non-healing wounds and traumatic wounds. Materials and methods: Our study was conducted on 30 patients in the Department of Orthopaedics, Kamineni Hospital, LB Nagar Hyderabad from May 2017 to June 2018. Out of 30 patients 18 male and 12 females, Mean age ranging from 19 to 58 for males and 20 to 60 for females. In our study, maximum cases were reported Road traffic accident 20 (67%) patients, followed by machinery injury in 6 (20%) patients and 4 (13%) patients had a fall from height. Vacuum Assisted Closure (VAC) dressing therapy applied for non-healing wounds and traumatic wounds. Results: Out of 30 wounds taken in the study, 20 wounds reduced in area & were resurfaced with split thickness skin grafting and 5 wounds showed reduction in area & were subjected to secondary closure. During start of VAC dressing therapy, all wounds were infected. At the end of VAC dressing, all wounds became swab negative during course of VAC dressing therapy, no patient required surgical debridement and there was gradual decrease in size of wound. Discussion: Our study showed that in VAC dressing therapy after day 3, there were 40% of patients who had no bacterial growth, and on day 7 there were 88% of patients who growth, whereas in saline-wet-tomoist patients only 10% of patients had no bacterial growth on the 8th day. Our study showed that VAC dressing therapy increases the vascularity and rate of granulation tissue formation compared to standard wound dressing therapy. Conclusion: VAC dressing provides sterile and controlled environment to large, educating wound surfaces by controlled application of sub-atmospheric pressure and prepares wounds for closure through split skin grafting and secondary closure in short time leading to less overall morbidity with decreased hospital stay.
Evaluation of Vacuum Assisted Closure Therapy for Soft Tissue Injury in Open Musculoskeletal Trauma
ABST RACT Introduction: The application of controlled levels of negative or sub atmospheric pressure for a prolonged period of time on a wound had shown to accelerate removal of excess fluid and promote hyperaemia, which eventually promote wound healing. Aim: The study was conducted with the aim to evaluate the effectiveness of Vacuum Assisted Closure (VAC) therapy for soft tissue injury in open musculoskeletal trauma. Materials and Methods: Twenty cases of complex musculoskeletal wound involving different parts of body were included in this progressive randomized study. In patients, aggressive debridement was done before the application of VAC therapy. Controlled negative pressure was uniformly applied to the wound. Dressings were changed after every 4 to 5 days. The evaluation of results included healing rate of the wound, eradication of infection, complication rate, and number of secondary procedures. Results: VAC therapy over the wound was administered for an average of 20.4 days ±6.72 days (range 14 to 42 days). There was decrease in wound size attained by VAC therapy ranged from 2.6 to 24.4 cm², with an average reduction of 10.55 cm². Three wounds were infected at the start of VAC therapy. However, all patients were cleared of bacterial infection by the end of VAC therapy. Conclusion: VAC therapy using negative pressure promote wound healing by increasing local capillary and increased rate of granulation tissue formation, decreases the duration of wound healing and requires fewer painful dressing change. Keywords: Negative Pressure, VAC, Wound Healing
The use of vacuum-assisted wound closure in musculoskeletal injuries
international journal of orthopaedics sciences, 2017
Background: This study was performed to evaluate the results of vaccum assisted wound therapy in patients with open musculoskeletal injuries or infected or exposed implant in situ (excluding arthroplasty) or traumatic wounds after debridement, infections after debridement at a tertiary care hospital, from 2013 to 2015.
Role of vacuum assisted closure therapy in chronic wounds: for some cases in Navi Mumbai
International Journal of Research in Medical Sciences, 2016
Background: This study was performed to evaluate the results of vacuum assisted wound therapy in patients with chronic non healing ulcer. Methods: The study was conducted in the department of General Surgery at a tertiary care hospital. It was an observational study with prospective design. The role of NPWT in various wounds was studied in 10 patients. Results: Out of 10 wounds taken in the study, 7 wounds reduced in area & were resurfaced with Split thickness skin grafting and 3 wounds showed reduction in area & were subjected to secondary closure. Conclusions: Vacuum assisted closure (VAC) therapy provides sterile and controlled environment to large, exudating wound surfaces and is treatment of choice in infected / nonhealing wounds, not responding to standard treatment.
International Journal of Research in Medical Sciences, 2021
Background: Aim of the study was to study the efficacy and cost-effectiveness of indigenously designed customized vacuum assisted closure (VAC) of wounds in our patients. The management of difficult to heal wounds has been the main force that led to the development of advanced gadgets for their management. The technique of vacuum assisted closure has revolutionized the management of difficult to heal wounds and delivers better results as compared to conventional technique. Our aim was to assess the efficacy and cost effectiveness of customized VAC therapy. Methods: This prospective study was conducted in the department of surgery and allied specialties, GMC Srinagar, from June 2018 and September 2020. During this period, 80 patients were subjected to VAC therapy and were included in this study. Results: VAC dressing was used in 80 patients. 55 were males and 25 were females. Most of the wounds in our study were located over lower limbs (70%). RTA was the most common mode of injury f...
The use of vacuum-assisted wound closure system for managementof difficult wounds
Biomedical Research-tokyo, 2013
We aimed to present the results of our different clinical practise experience about the treatment and management of extremely difficult wounds using the vacuum-assisted closure system (VAC). In this retrospective study, we analysed the records of 51 consecutive patients who were applied VAC for different clinical practise between 2008 and 2012 at the Izmir Katip Celebi University, Ataturk Education and Training Hospital. There were 51 patients in our study with an average age of 54.6(16-78) years and 22(43.1%) were male, and 29(56.9%) were females. We used VAC system to manage the wound in 29(56.9%) patients with wound dehiscence (with or without fascial necrosis), in 17(33.3%) patients with open abdomen, and in 5(9.8%) patients with Fournier gangrene. The average hospital stay was38.4 days (10-101). The average duration of VAC application was 24.3 (8-56) days. The average number the application of VAC dressingswas 12.01 (3 to 28).Directly VAC related complications (enteroatmospheric fistula and wound haematoma) were seen in two patients (3.9%). A total of 27(52.9%) patients underwent delayed primary or graft closure. In the remaining 19(37.2%) patients, the wound was left to granulate and heal by secondary intention.5 (9.8%) patients died because of complications related to primary disease while on VAC application.We concluded that VAC is an important tool in the armamentarium of the surgeons managing in patients with complex and difficult wounds, particularly, in cases of open abdomen.
Outcome of Vacuum Assisted Closure (VAC) Therapy in Wound Management.
IOSR Journals , 2019
Acute and chronic wounds affect at least 1% of the population. In clinical practice many wounds are slow to heal, difficult to manage and represent a significant risk factor for hospitalization, amputation, sepsis, and even death. In addition to the pain and suffering, failure of the wound to heal also imposes social and financial burdens. From the patient's perspective, wound therapy is often uncomfortable and painful. Recently introduced technique of topical negative pressure therapy or vacuum assisted closure (VAC) has been developed to try to overcome some of these difficulties. The purpose of this study is to assess outcome of VAC dressing in acute and chronic wounds.
2020
Introduction: Vacuum-Assisted Closure (VAC) uses negative pressure to assist wound healing. Negative pressure drains fluid from the wound, thus removing the substrate for growth of microorganisms. Negative pressure may also accelerate granulation tissue formation and promote angiogenesis. The mechanical stimulation of cells by tensile forces may also play a role by increasing cellular proliferation and protein synthesis. Negative Pressure Wound Therapy (NPWT) involves the use of a negative pressure therapy or suction device to aspirate and remove fluids, debris and infectious materials from the wound bed to promote the formation of granulation tissue. Material and Methods: A total o 25 cases of ulcers between August 2019 and June 2020 were taken for study. Out of 25 patients 18 were males and 7were females, Mean age ranging from 22 to 70 for males and 18 to 57 for females. In our study, maximum cases reported were diabetic ulcers 19 (76%), road traffic accidents 4 (16%) patients and...