Can a wound vacuum (VAC) be placed on a closed wound?

Can You Place a Wound VAC on a Closed Wound?

Yes, negative pressure wound therapy (VAC) can and should be placed on closed surgical incisions, particularly high-risk wounds, to reduce complications including wound dehiscence and infection. 1

Evidence-Based Recommendation

Application of incisional NPWT on closed incisions to facilitate healing should be considered (Grade B recommendation). 1 Once closure of the fascia and skin have been achieved, it is possible to use NPWT to support healing of the closed laparotomy incision and prevent complications. 1

Clinical Benefits of VAC on Closed Incisions

Reduction in Wound Complications

• A significant reduction in wound complications including wound dehiscence was observed compared with standard gauze dressings in comparative studies. 1
• Two comparative retrospective studies demonstrated a significant reduction in wound complications overall and in particular a reduced incidence of infection in wounds treated with incisional NPWT compared with standard dressings. 1

Mechanical Support and Patient Mobility

• The "splinting effect" of NPWT application aids patient mobility by supporting the wound, which is particularly important in the postoperative period. 1
• Early patient mobility is thought to be important in reducing duration of ICU stay and improving long-term outcomes. 1

Specific Clinical Scenarios

High-Risk Abdominal Incisions

• NPWT has been used to support healing of high-risk abdominal incisions in procedures where the abdomen is closed at the index operation. 1
• This application is particularly valuable for patients at elevated risk for wound complications due to factors such as obesity, diabetes, contamination, or emergency surgery. 1

Post-Open Abdomen Management

• Once closure of the fascia and skin have been achieved following open abdomen management, NPWT can be applied to the closed incision to facilitate healing. 1

Evidence from Other Surgical Specialties

The use of NPWT on closed incisions has been demonstrated to good effect in other clinical indications beyond abdominal surgery. 1 Several comparative studies have been reported in other indications which principally show the reduction in complications that can be achieved through application of NPWT to a closed incision. 1

Critical Technical Considerations

Proper Application

• The VAC system requires an airtight seal to maintain negative pressure (typically 50-80 mmHg continuous suction), which is essential for fluid evacuation and the mechanical effects that promote healing. 2
• The wound VAC works through negative pressure that compresses specialized polyurethane foam, creating a "splinting effect" and evacuating approximately 800ml of fluid to prevent pooling. 2

What NOT to Do

• Never attempt to combine VAC therapy with compression dressings like Unna boots, as this would disrupt the VAC seal and prevent the negative pressure system from functioning properly. 2
• Do not apply VAC over skin that is thin and easily bruised or abraded, as the adhesive removal can cause tissue damage. 3, 4

Contraindications for VAC on Any Wound (Open or Closed)

• Patients with allergic reactions to any of the components that contact the skin (polyurethane sponge, adhesive, or plastic film). 3, 4
• Patients with neoplasm as part of the wound floor. 3
• Patients who are fully anticoagulated may need careful monitoring in an intensive care setting. 4

Monitoring and Management

• Inspect the VAC seal regularly to ensure proper function and negative pressure maintenance. 2
• Monitor for signs of infection (redness, swelling, foul drainage, increased pain, fever) despite the reduced infection risk with VAC therapy. 5
• The frequency of dressing changes should be determined by clinical need, typically every 48-72 hours for closed incision VAC therapy. 5