From the Guidelines
Wound vacuum-assisted closure (VAC) therapy should be considered as an adjunct therapy to standard of care for the healing of postsurgical diabetes-related foot wounds, as recommended by the most recent guidelines [ 1 ].
Key Considerations for Wound VAC Therapy
- The wound should be clean with adequate debridement of necrotic tissue
- The wound should have sufficient blood supply to support healing
- The wound should be large enough to accommodate the VAC sponge
- The patient should not have untreated osteomyelitis, malignancy in the wound, exposed blood vessels or organs, or untreated coagulopathy
Mechanism of Action
Wound VAC therapy works by:
- Removing excess fluid
- Reducing edema
- Increasing blood flow
- Promoting granulation tissue formation
- Reducing bacterial colonization
Treatment Protocol
- Apply a specialized foam dressing to the wound cavity
- Seal the dressing with an adhesive drape
- Connect the dressing to a vacuum pump that applies negative pressure (typically 75-125 mmHg) continuously or intermittently
- Change the dressing every 48-72 hours
Benefits of Wound VAC Therapy
- Reduces healing time
- Reduces the need for surgical interventions
- Effective for wounds that have failed to respond to conventional treatments
- Improves patient outcomes and quality of life [ 1 ].
From the Research
Wound Vac Criteria
The following are the criteria and applications of wound vac, also known as negative pressure wound therapy (NPWT):
- Chronic wounds, including those caused by venous and arterial insufficiency, diabetic complications, and pressure-induced ulcers, can be treated with NPWT 2
- The method of NPWT application includes thorough debridement, adequate haemostasis, and application of sterile foam dressing, with a fenestrated tube embedded in the foam and connected to a vacuum pump with fluid collection container 3
- NPWT stabilizes the wound environment, reduces wound edema/bacterial load, improves tissue perfusion, and stimulates granulation tissue and angiogenesis 3
- The VAC dressings are typically changed on the 3rd day, with continuous or intermittent suction ranging from 50 to 125 mmHg 3
- NPWT with instillation (NPWTi) has been shown to be more effective than traditional NPWT in reducing post-debridement bioburden in chronically infected lower extremity wounds 4
- NPWTi is associated with higher rates of wound closure without increasing complication rates in patients with necrotizing soft tissue infections compared to traditional NPWT or moist wound care dressing 5
Indications for Use
NPWT can be used for various types of wounds, including:
- Chronic wounds, such as venous ulcers, diabetic foot ulcers, and pressure ulcers 2
- Difficult wounds, such as those with significant tissue loss or infection 3
- Necrotizing soft tissue infections, such as necrotizing fasciitis, Fournier gangrene, and gas gangrene 5
- Chronically infected lower extremity wounds 4
Mechanisms of Action
NPWT works by: