VACUUM ASSISTED WOUND THERAPY

VAC THERAPY

1. VACUUM ASSISSTED CLOSURE: A NOVEL WOUND HEALING TECHNIQUE Presented by Guide: BINUJA S.S. PRASANTH M.S

2. 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

3. 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.

4. 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.

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.

6. MECHANISM OF WOUND HEALING

7. NOVEL CONCEPTS IN WOUND HEALING Wound dressing Dry dressing Wet-to-dry dressing Foam dressing Alginate dressing Hydro-fibre dresssing Transparent film dressings Hydrogel dressing Hydrocolloid dressing

8. 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.

9. 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)

10. VAC SYSTEM

11. VAC PUMP

12. SPONGE Polyurethane Foam Poly-vinyl-alcohol Pore size: 400-600 microns Pore size: 0.2 -1mm

13. Tube For fluid For measurement Multi-lumen

14. 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

15. 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

16. 1.Clean wound thoroughly Aggressive cleaning of the wound at each dressing change is imperative to decrease bacterial load and minimize odor

17. Cut foam Cut the foam to fit the size and shape of the wound, including tunnels and undermined areas

18. Lay foam in wound Gently place the foam into the wound cavity, covering the entire wound base and sides, tunneling and undermining

19. Cut the drape Cut the drape large enough to cover the foam and 3-5 cm of surrounding healthy tissue with drape.

20. 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

21. Applying the suction tubing Cut hole in drape about 1.5 cm and apply tubing

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

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

24. Canister CANISTER WITH ISOLYSER Canister comes with Isolyser gel that gels fluid on contact and helps eliminate odor

25. USES OF VAC THRAPY Acute Surgical Wounds

26. 2. Pressure Ulcers

27. 3. Diabetic Wounds

28. 4. Open Abdominal Wounds

29. ADVANTAGES Provides 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.

30. 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.

31. 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.

32. In patients with wound dehiscence after abdominal open surgery. Management of Postpneumonectomy Empyema . Management of lung abscess. Treatment of mastitis assossiated chronic breast wounds.

33. 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.

34. 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

35. 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.

36. 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 Thorac Surg;88:1131-6.