From the Guidelines
For a knee abscess skin infection treated with Vacuum-Assisted Closure (VAC) therapy, the recommended settings are typically continuous negative pressure between -125 to -150 mmHg, as supported by the most recent and highest quality study available 1. The dressing should be changed every 48-72 hours. Before VAC application, the abscess should be surgically drained and debrided to remove all necrotic tissue and purulent material. The VAC foam should completely fill the wound cavity with an occlusive seal. For infected wounds, the black polyurethane foam is generally preferred over the white foam as it provides better granulation tissue formation. Antimicrobial dressings may be placed beneath the foam in heavily contaminated wounds. The therapy usually continues until the wound bed shows healthy granulation tissue, typically 1-3 weeks depending on wound size and healing progress. VAC therapy works by removing excess fluid, reducing bacterial load, increasing local blood flow, and promoting granulation tissue formation. Patients should also receive appropriate systemic antibiotics based on culture results to address the underlying infection while the VAC therapy manages the wound locally, as recommended by the Infectious Diseases Society of America 1. It is essential to note that the management of skin and soft-tissue infections, including abscesses, involves a combination of surgical intervention, antibiotic therapy, and wound care, with the goal of promoting healing and preventing complications 1. The specific treatment approach may vary depending on the severity of the infection, the presence of underlying medical conditions, and the patient's response to initial treatment. In general, the treatment of skin and soft-tissue infections should be guided by evidence-based recommendations and clinical practice guidelines, such as those provided by the Infectious Diseases Society of America and other reputable organizations 1.
From the Research
Wound Vac Settings for Knee Abscess Skin Infection
The recommended VAC settings for a knee abscess skin infection are not explicitly stated in the provided studies. However, the following information can be gathered:
- Vacuum-assisted closure therapy is used for the treatment of skin and soft-tissue infections, including those of the extremities 2.
- A high-vacuum wound drainage system can reduce pain and length of treatment for pediatric soft tissue abscesses 3.
- Vacuum-assisted dressing (VAD) is a comparatively newer modality for treating chronic non-healing wounds, which helps in faster wound healing, decreases the frequency of dressing, and reduces hospitalization time 4.
- Vacuum-assisted wound closure (VAC) is a wound management technique that exposes the wound bed to negative pressure, improving blood supply and stimulating cellular proliferation of reparative granulation tissue 5.
Key Considerations
- The application of VAC therapy may vary depending on the specific wound and patient conditions.
- The technique is contraindicated in patients with thin, easily bruised or abraded skin, those with neoplasm as part of the wound floor, and those with allergic reactions to any of the components that contact the skin 5.
- Clinical experience with VAC therapy has resulted in a low incidence of minor, reversible irritation to surrounding skin and no major complications 5.
Settings and Outcomes
- In one study, infected wounds had dressings changed every 48 hours, whereas all others had dressings changed every 72 to 96 hours 6.
- The duration of VAC use, final wound closure outcome, and costs versus standard dressing changes or free flaps should be considered when applying VAC therapy 6.
- The vacuum-assisted closure device can be used as a bedside procedure, but additional soft tissue reconstruction may be needed for definitive coverage 6.