Introduction
Vacuum-assisted closure (VAC) is one of the significant achievements of modern medicine, which allows the healing of various wounds. This method is widely accepted for treating surgical sutures, burns, frostbite, bedsores, acute injuries, chronic wounds, and gunshot damages. Vacuum-assisted closure, well-known also as negative pressure wound therapy (NPWT) and the wound VAC, is a medical procedure that utilizes negative pressure to clean the injury surface and promote its rapid healing. Despite all the significant advantages of VAC and its high effectiveness in recovery, one should not forget about the existence of certain risks and contraindications, which must be familiar to all patients.
VAC: Peculiarities of Treatment
VAC is effective even in cases when the wound cannot be healed by other means. The primary type of injury treatment around the world has remained the periodic change of medical dressing. However, in 30%, it turns out to be non-effective, and in 10-30%, it does not prevent infection and inflammation (Li et al., 2017). Therefore, NPWT is gaining popularity among patients around the world. It is a non-pharmacologic and non-surgical medical method of wound management, proposed in 1997 and used as an “adjunct or alternate to surgery” (Agarwal et al., 2019, p. 845). Due to negative pressure, VAC therapy reduces swelling and improves blood circulation, which helps accelerate tissue regeneration. In most cases, it helps to avoid infection, ischemia, and necrosis and promotes tissue perfusion (Eldenburg et al., 2020). Thus, the wound VAC keeps an injury moist, increases blood flow, and decreases the infection rate.
This type of healing is carried out using special devices, which there are both disposable and reusable. Reusable stationary devices are utilized in clinics, while some tools can be bought and used at home. Most devices consist of gauze or foam dressing and “semi-transparent biological films to cover the wound area,” then the dressing is connected “with negative-pressure device by drainage” (Li et al., 2017, p. 2211). The treatment process is quite simple: with the help of a tube, the fluid that has arisen due to inflammation is sucked out of the wound, and the membrane creates a vacuum inside the injury. Due to its ease of use, a person without medical education can utilize this device; just a little practice is enough.
Merits and Demerits of VAC, Risks and Potential Complications
Patients having faced VAC therapy highlight several advantages and disadvantages of this method. As for VAC merits, this technic allows less often changing the medical dressing, which does not move and better protects the wound. Moreover, NPWT is pretty effective in healing various injuries, including even “chronic ulcer ones” (Li et al., 2017, p.2215). Among demerits, patients call discomfort of wearing vacuum pumps and the price because negative pressure treatment costs more expensively than traditional medical dressings (Achten et al., 2018). However, this procedure allows avoiding surgical site infection, which can cause reoperation and require even higher additional costs (Badia et al., 2017, p. 2). Thus, although VAC therapy is a modern solution to healing wounds of different types, it has several disadvantages, which do not decrease its effectiveness.
Although the positive effect of therapy is substantial, there are also several risks connected with its use. Firstly, one of the essential VAC risks is the likelihood of bleeding. Secondly, it can damage the nerves, tendons, or blood vessels (Achten et al., 2018). Thirdly, VAC may cause bowel dysfunction and wound infection, but the likelihood of these events is low. Complications of VAC treatment can include “allergies to the adhesive drape, excoriation of the skin, restricted mobility, adherence of the tissues to the foam, and lack of patient compliance” (Agarwal et al., 2019, p. 846). There are such absolute contraindications of using VAC as unstable hemostasis, fistulas of unclear origin, and necrotic or malignant wounds. The therapy is contraindicated in the cases of “a large number of necrotized tissue or defects in the walls, an active septic site that was not subject to rehabilitation” (Sakhanda & Orlov, 2019, p. 44). Although complications are infrequent, sometimes, macerated skin and the development of enteric fistula can be caused by this treatment method. Thus, each patient must take into account the possible risks of this procedure.
What Patients Should Also Know
As before any other medical procedure, each patient should consult a doctor and consider some features of the VAC treatment process. Only a physician, reviewing the patient’s case history, can decide whether negative pressure wound treatment will be effective. In addition, the specialist must determine the necessary duration of the use of this therapy. The average treatment time is 11 days; usually, treatment lasts from 10 to 16 days, depending on the wound’s type and condition (Li et al., 2017). Hence, consultation with a doctor should become the first step to knowing the foundations of vacuum-assistant closure.
Since it is possible to use a VAC device not only in a healthcare setting but also at home, each patient should understand how it works and be trained on how to utilize it. The patient should be familiarized with how often it is necessary to change the dressing. Usually, it needs to be done every two days, but it depends on the condition of the wound. The VAC devices are powered by a rechargeable battery and have a container that collects fluid that has been pumped out of the injury. When the container is complete, it must be immediately replaced. The VAC device does not interfere with leading an everyday life and even driving a car in most cases, increasing the patient’s comfort (Agarwal et al., 2019). However, such issues should be discussed with the doctor. The patient should consult a specialist without delay if he faces increasing bleeding or pain. Negative signs are an unpleasant odor from the wound or a change in the color of the pumped fluid. Therefore, physicians and nurses should ensure that patients are thoroughly familiar with the rules of VAC devices’ use.
Conclusion
VAC therapy is a huge step forwards in medicine, accelerating the healing of various types of wounds; however, like any medical procedure, it has several demerits and is recommended not for all patients. Due to the effect of negative pressure, VAC cleans the wound, improves blood circulation, and reduces the infection rate. The functioning of this method is provided with specific devices, which could be utilized in clinical settings and at home. All patients should consult a doctor and be well trained to use such devices. Thus, VAC therapy reducing swelling and decreasing the wound size contributes to a quick recovery of patients if they are ready to listen to their doctors’ recommendations.
References
Achten, J., Vadher, K., Bruce, J., Nanchahal, J., Spoors, L., Masters, J. P., Dutton, S., Madan, J., & Costa, M. L. (2018). Standard wound management versus negative-pressure wound therapy in the treatment of adult patients having surgical incisions for major trauma to the lower limb—a two-arm parallel group superiority randomized controlled trial: Protocol for Wound Healing in Surgery for Trauma (WHIST). BMJ Open, 8(6). Web.
Agarwal, P., Kukrele, R., & Sharma, D. (2019). Vacuum assisted closure (VAC)/negative pressure wound therapy (NPWT) for difficult wounds: A review.Journal of Clinical Orthopaedics and Trauma, 10(5), 845-848. Web.
Badia, J. M., Casey, A. L., Petrosillo, N., Hudson, P. M., Mitchell, S. A., & Crosby, C. (2017). Impact of surgical site infection on healthcare costs and patient outcomes: A systematic review in six European countries. Journal of Hospital Infection, 96, 1-15. Web.
Eldenburg E., Pfaffenberger M., & Gabriel, A. (2020). Closure of a complex lower extremity wound with the use of multiple negative pressure therapy modalities. Cureus, 12(7). Web.
Li, Z., Wang, Q., Mi, W., Han M., Gao, F., Niu, G., & Ma, Y. (2017). Effects of negative-pressure wound therapy combined with microplasma on treating wounds of ulcer and the expression of heat shock protein 90. Experimental and Therapeutic Medicine, 13, 2211-2216. Web.
Sakhanda, I., & Orlov, O. (2019). Application of VAC therapy in the treatment of the diabetic foot. Technology Transfer: Innovative Solutions in Medicine, 44-46. Web.