NEGATIVE PRESSURE

WOUND THERAPY(VAC)

PRESENTOR-Dr MOHAMMED NAYEEMUDDIN

MODERATOR-Dr SACHIN SHAH

INTRODUCTION Wound is defined as an interruption in the

continuity of the body surfaces like burns , laceration and crushing injuries.

Inflammation which occurs at the site of wound causes angiogenesis thus increasing the local blood supply.

Factors influencing wound healing are pressure , trauma vascular insufficiency , diabetes , infection and prolonged immobilisation are some of them.

Negative pressure wound therapy with reticulated open cell foam (NPWT-ROCF) also called as vacuum assisted closure (VAC).

VAC has evolved as a beneficial adjunctive treatment modality for soft tissue management after high energy trauma.

DEBRIDEMENT – is defined as a process of removing dead necrotic tissue and foreign materials from and around a wound to expose healing tissue.

SURGICAL DEBRIDEMENT : is defined as a process in which scalpel , scissors or other surgical instruments are used to cut out the necrotic tissue from the wound. It is also known as sharp debridement.

INDICATIONS Soft tissue trauma with or without underlying fractures is

the best indication of VAC. Pressure skin grafts and to improve skin graft incorporation

and also can be applied on donor site to epithelize it. VAC can be applied on exposed bones , tendons and

orthopaedic implants. Post traumatic ulcers Diabetic foot with large wounds. Wound after fasciotomy. Infected wounds after debridement. Post operative infection. Chronic osteomyelitis Surgical incisions that cannot close without tension. Closed surgical incision with continued drainage especially

if the wound have serous drain on post op day 4. Necrotizing fasciitis.

THE MACHINE AND MECHANISM. As a result of continuous research on

the effect of subatmospheric pressure on open wounds . kinetic concepts Inc (KCI, San antonio ,TX) developed the KCI vacuum assisted closure (VAC) system.

A VERY SIMPLE ANALOGY

Pump

Canister

Sponge

Pump

Canister

Sponge

Pump

SPONGE Polyurethane Foam Poly-vinyl-

alcohol

0.2 to 1mmPore size: 400-600 microns

T.R.A.C.™ TUBING

multi-lumen

For FluidFor Measurement

HOW TO AVOID PAIN Moisten the interface between sponge

and wound. Apply cuticle to the wound then NPWT. Topical lidocaine on the wound surface.

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

COMPLICATIONS Do not apply on nondebrided dirty wounds. May cause bleeding if any cut vessel is in the

vicinity of the wound on where NPWT is to be applied.

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.

TECHNICAL COMPLICATIONS Leakage may occur in cases of power

loss resulting in maceration and may cause infection and wound complications.

Poor sealing leading to loosening of drainage system.

CONTRAINDICATION Necrotic tissue with eschar. Exposed nerves and organs. Undernourished patient. Severe pain. Malignant wound. Nonenteric and unexplored fistulas

ANTIBIOTIC BEADS WITH VAC It is a controversial topic as antibiotic is

lost when fluid. But in authors institute it is followed as

the 5 minutes interval of VAC exerts a beneficial effect.

INCISIONAL VACCUM – ASSISTED CLOSURE (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.

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.

VACUUM – ASSISTED CLOSURE 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.

This movement of irrigant is supported by the work of Labler and Trantz.

Further studies are required to give definite recommendations.

NEW RESEARCH Modern papineau technique : involves

aggressive excisional debridement of infected or necrotic bone with open bone grafting with cancellous bone accompained by VAC.

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