Should Vacuum-Assisted Closure (VAC) be used instead of Hydrofera for wound treatment?

VAC vs Hydrofera for Wound Treatment

Negative pressure wound therapy (VAC/NPWT) should be used instead of Hydrofera for most wound scenarios, particularly for post-surgical wounds, necrotizing infections after complete debridement, and wounds requiring enhanced granulation tissue formation.

Clinical Context and Evidence Base

The available guidelines and evidence strongly favor NPWT/VAC therapy across multiple wound types, while Hydrofera (a foam dressing) receives minimal mention in high-quality guidelines. The decision framework depends on wound type and clinical scenario:

Post-Surgical Wounds

NPWT demonstrates superior outcomes for post-surgical wounds compared to standard dressings. 1

• In diabetic foot post-amputation wounds, NPWT achieved 43.2% complete closure versus 28.9% with advanced wound therapy (P = .007) 1
• For deep sternal wound infections after cardiac surgery, NPWT achieved 100% complete healing with median application time of 9.3 days, serving as either definitive therapy (45.5% primary closure) or bridge to reconstructive surgery (54.5%) 2
• Post-surgical wounds show shortened duration between excision and delayed closure or grafting with NPWT 1

Necrotizing Soft Tissue Infections

NPWT should be considered after complete surgical debridement of necrotizing infections. 1

• Sub-atmospheric pressure improves local wound environment through increased blood supply, reduced edema, fluid absorption, bacterial inhibition, and accelerated granulation tissue formation 1
• NPWT promotes migration of inflammatory cells and removes bacterial contamination and exudates 1
• The 2018 WSES guidelines specifically recommend considering NPWT for wound care after complete necrosis removal in necrotizing infections (Grade 1C) 1

Open Abdomen Management

NPWT with continuous fascial traction is the preferred technique for temporary abdominal closure. 1

• The 2018 WSES guidelines recommend NPWT with continuous fascial traction as preferred temporary abdominal closure technique (Grade 2B) 1
• NPWT results in superior delayed fascial closure rates compared to non-negative pressure systems 1
• For severe peritonitis patients specifically, negative pressure temporary closure showed favorable outcomes in mortality and abdominal closure rates 1

Chronic Diabetic Foot Ulcers

For chronic non-surgical diabetic foot ulcers, the evidence for NPWT is mixed and should be used selectively. 1, 3

• Four RCTs examining NPWT versus standard care for chronic non-surgical ulcers were all at high risk of bias 1
• The American Diabetes Association recommends considering NPWT as one of several adjunctive treatments for chronic ulcers that have failed optimal standard care 3
• Sharp debridement remains preferable to topical agents as the foundation of wound care 1, 3

Mechanism of Action Advantages

NPWT provides multiple physiologic advantages over passive dressings like Hydrofera: 4, 5

• Removes chronic edema leading to increased localized blood flow 4
• Applied mechanical forces enhance granulation tissue formation 4
• Stabilizes wound environment and reduces bacterial load 5
• Improves tissue perfusion and stimulates angiogenesis 5
• Reduces wound volume, depth, and treatment duration compared to conventional dressings 5

Critical Caveats and Limitations

NPWT should never replace proper surgical debridement and conventional therapy. 1

• The Infectious Diseases Society of America states that for infected wounds, available evidence is insufficient to recommend routine use of NPWT for treatment or prophylaxis 1
• NPWT should not be used as a substitute for proper surgical debridement 1
• Sharp debridement with scalpel, scissors, or tissue nippers remains the gold standard and is generally preferable to any topical agent 1, 3

Hydrofera dressings lack guideline-level evidence. While Hydrofera foam dressings are mentioned in one guideline for hidradenitis suppurativa post-surgical wounds with reported good patient satisfaction, no comparator groups were available and the evidence quality is low 1. No major guidelines recommend Hydrofera as a preferred treatment modality.

Practical Algorithm

1. Perform adequate surgical debridement first - this is non-negotiable 1, 3, 6
2. For post-surgical wounds: Use NPWT as first-line adjunctive therapy 1, 2
3. For open abdomen: Use NPWT with fascial traction 1
4. For necrotizing infections: Complete debridement first, then consider NPWT 1
5. For chronic diabetic ulcers: Optimize standard care (debridement, off-loading, infection control) first; consider NPWT only if failed after 30+ days 1, 3
6. Avoid NPWT as substitute for proper surgery or as routine prophylaxis for infected wounds 1

The evidence strongly favors NPWT/VAC over Hydrofera for most clinical scenarios where advanced wound therapy is indicated, with the critical caveat that neither replaces proper surgical technique and standard wound care principles.