Vac therapy

Vac therapy, negative wound therapy

1. VAC DRESSING BY: DR ANIL KUMAR P MODERATOR : DR NAGAKUMAR J S PROFESSOR AND HOU DEPT OF ORTHOPAEDICS

2. 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, is also considered wounds. 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.

3. 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.

4. STANDARD WOUND MANAGEMENT Initial surgical debridement (a rapid and effective technique to remove devitalized 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.

5. 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 MOA: Effect of subatmospheric pressure on open wounds

6. MECHANISM OF WOUND HEALING

7. 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.

8. 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 raw wound closed (wound contraction)

9. Reduction of edema has positive effect in wound healing Reduction of inhibitory factors contained in interstitial fluid (chemical) Decompression of small blood vessels , which restores flow (mechanical ) Negative Pressure Wound Therapy increases perfusion and oxygenation

10. RANGE OF PRESSURE IN VAC MACHINE Standard : -125 mmHg. Range : - 125 to – 200 mmHg Neonates : - 50 mmHg. Children < 2 years : -50 to -75 mmHg Children > 2 years : -75 to -125 mmHg Adults : -125mmHg

11. COMPONENTS

12. VAC SYSTEM

13. SPONGE Polyurethane Foam Poly-vinyl-alcohol Pore size:400-600 microns : hydrophobic Promotes aggressive granulation Pore size: 100-150 microns ; hydrophilic Doesn’t promote granulation

14. Flexible foam dressing adapts to the contours of deep & irregular surface of the wound bed Specially designed hydrophobic, non-linear networked foam dressing removes bacteria colonised wound exudate The foam dressing aggressively promotes uniform healthy granulation tissue throughout the wound bed

15. T ube ( Multi-lumen)

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

17. STEPS 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

18. 1.CLEAN WOUND THOROUGHLY Aggressive cleaning of the wound at each dressing change is imperative to decrease bacterial load and minimize odor

19. 2.CUT FOAM Cut the foam to fit the size and shape of the wound, including tunnels and undermined areas

20. 3.LAY FOAM IN WOUND Gently place the foam into the wound cavity, covering the entire wound base and sides, tunneling and undermining

21. 4.CUT THE DRAPE Cut the drape large enough to cover the foam and 3-5 cm of surrounding healthy tissue with drape.

22. 5.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

23. 6.APPLYING THE SUCTION TUBING Cut hole in drape about 1.5 cm and apply tubing

24. 7.CONNECT TO CANISTER Connect dressing tubing to canister tubing, making sure clamps are open

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

26. 8.CANISTER(+ ISOLYSER ) Canister comes with Isolyser gel that gels fluid on contact and helps eliminate odor

27. video

28. USES OF VAC THERAPY 1. Acute Surgical Wounds

29. 2. Pressure Ulcers

30. 3. Diabetic Wounds

31. 4. Open Abdominal Wounds

32. Full thickness and partial thickness burns Diabetic / Neuropathic ulcers Venous Insufficiency ulcers Post-operative and dehisced surgical Traumatic Wounds Skin Flaps and Grafts Explored fistulas

33. ADVANTAGES Provides more effective therapy because target sub atmospheric pressure is maintained - 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.

34. OUTCOMES EXPECTED Gradual reduction of fluid and surface area should be observed with each assessment. Colour of wound bed should become a deeper red as perfusion to the site increases. Measurements should decrease weekly. If healing is not observed in a week, treatment should be re-evaluated. The average treatment with NPWT is 1-4 weeks. Length of treatment is determined by goals of therapy

35. 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 .

36. CONTRAINDICATIONS Exposed blood vessels(no protective fascia) Untreated osteomyelitis Unexplored fistulas Malignant wounds Necrotic tissue with eschar present Non -enteric fistulas Exposed or unprotected organs Active bleeding or patient on anticoagulant therapy Bony fragments Untreated malnutrition Non -compliant or combative behaviour

37. COMPLICATIONS Pain may occur while removing the adhesive tape. Retained sponge may lead to infection. Dehydration in children occurs due to suction of fluids from the wound. Maceration of skin can occur if the foam overlaps the healthy skin. Hematoma in surrounding tissue may occur. In immune compressed individuals wound dehiscence can occur . Leakage may occur in cases of power loss resulting in maceration and cause infection and wound complications. Poor sealing leading to loosening of drainage system.

38. INTERVENTIONS THAT WILL MAXIMIZE HEALING Debride wound prior to Negative Pressure Therapy Off load pressure ulcers consistently Minimize time off NPWT to < 4 hours in a day Manage co-morbid condition Reduce edema Minimize infection Control blood glucose level

39. 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

40. THANK YOU

41. VAC INSTILL Daniel – schlatterer has described instill irrigation technique is a gravity dependent filtration of the irrigant into the wound bed for approximately 30 seconds. This is followed by a short time period of no suction . This incubation phase is referred to us the dwell or hold time period. The solution reaches the wound bed after traversing the pressure foam dressing. Further studies are required to give definite recommendations.

42. INCISIONAL VAC (IVAC) Apply VAC on primary closure. Used in high risk surgical closure of wound. High energy tibial plateau fracture. Calcaneal fractures. Pilons fractures. Acetabular fracture. Amputed limbs in diabetes. Previously irradiated tissue. Morbidity obese patient. Incisions in hip and knee replacement surgeries.

43. ADVANTAGES OF IVAC After traumatic wound or surgical incision , the tensile forces cause gapping of the wound. If wound is kept without coverage becomes impossible . NPWT exerts a contracting effect on the wound that pulls the edges together and the wound become slowly smaller and smaller with each NPWT and it is then possible to do primarily close the wound. Vacuum assisted closure system appears as a thermal insulation and prevention a loss of heat. This is a special important onces in burns , physiological unstable and polytraumatized patients .

44. Monitor frequently Observe wound and peri-wound area for signs and symptoms of infection Remove dressings carefully to protect new tissue growth. Bright gush flow red blood in canister requires immediate evaluation.

45. Monitor frequently Observe wound and peri-wound area for signs and symptoms of infection Remove dressings carefully to protect new tissue growth. Bright gush flow red blood in canister requires immediate evaluation.