MANAGEMENT OF WOUND VACUUM ASSISTED CLOSURE

Management of Wound Vacuum Assisted Closure

Management of Wound Vacuum Assisted Closure

Introduction

Vacuum assisted closure (also called vacuum therapy, vacuum sealing or topical negative pressure therapy) is a sophisticated development of a standard surgical procedure, the use of vacuum assisted drainage to remove blood or serous fluid from a wound or operation site. In essence the technique is very simple. A piece of foam with an open-cell structure is introduced into the wound and a wound drain with lateral perforations is laid on top of it. The entire area is then covered with a transparent adhesive membrane, which is firmly secured to the healthy skin around the wound margin. When the exposed end of the drain tube is connected to a vacuum source, fluid is drawn from the wound through the foam into a reservoir for subsequent disposal.

Background

The healing of a wound is often time consuming, costly, and painful for the client undergoing the specific treatment modality. In an attempt to devise a method and device for treating wounds that would provide a positive outcome while being cost effective, Argenta and Morykwas (1997) developed vacuum-assisted closure therapy. VAC therapy was developed at the Bowman Gray School of Medicine at Wake Forest University in Winston-Salem, North Carolina (Mendez-Eastman, 1998). I received approval for use by the FDA in 1995 for treating a variety of chronic wounds (Hiltabidel & Valenzuela, 2001).

Initially, Argenta and Morykwas (1997) and colleagues studied the us of the VAC device in chronic wound healing by secondary intention using an animal model. Argenta and Morykwas (1997) compared the use o negative pressure from the VAC device versus the use of moistened saline gauze dressings in evaluating animals with tissue defects. It was determined that negative pressure generated by the VAC device was superior to moistened saline gauze in promoting granulation tissue development in the wound bed while increasing local blood flow (Hartnett, 1998).

Based on their studies with animal models, Argenta and Morykwas (1997) studied the effects of the VAC device on the healing of chronic, subacute, and acute wounds in humans VAC therapy was used in treating 175 chronic wounds which were defined as those open for more than 7 days Chronic wounds stemmed from venous insufficiency, diabetes mellitus, and pressure injury. Subacute wounds, consisting of 97 total in the study, were wounds open less than 7 days. This category included avulsions and open amputations Evaluation of 31 acute wounds which were open for less than 12 hour included gunshot wounds and eviscerations.

VAC therapy was used until complete wound healing occurred o the defect was minimized enough so that a less-extensive surgical intervention could be instituted, or until the wound could be closed by delayed primary intention. The outcome of the study indicated that 269 of the wounds treated with VAC therapy responded favorably to treatment as indicated by enhanced formation of granulation tissue (Hartnett, 1998).

Problem

One of the most difficult and time-consuming challenge faced by nursing and other health care providers is the patient who presents with ...