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How to cite this article: Muhammad Saaiq. VAC

Valuable Adjunct to Wound Care Armamentarium. Ann Pak Inst Med Sci 2012;8(2):

Therapy: A

EDITORIAL

VAC

Therapy: A Valuable Adjunct to Wound Care Armamentarium

Muhammad Saaiq Assistant Professor, Burn Care Centre/ Plastic Surgery, PIMS, Islamabad.

E-mail muhammadsaaiq5@gmail.com

Medicine is an ever

evolving science. The present day medicine is termed as evidence based

medicine wherein practice and policies are guided by sound clinical and experimental evidence

supporting the

benefits and safety of a given therapeutic modality. Over the last decade,

Vacuum Assisted Closure therapy

(VAC therapy) has emerged as a novel adjunct to the

management of surgical wounds across a range of specialties. 1-3

How does the VAC therapy work? Since the technique is relatively new, its exact mechanism

of action still continues to be researched. A variety of interrelated factors have been identified to

account for its favorable effects on wound healing. These factors can be summarized into three

subgroups i.e.

removing, reducing and Improving.

Firstly the edematous tissue planes

surrounding the wound are characterized by localized collection of interstitial fluid that contains

inhibitory factors that suppress mitosis, fibroblasts activity, collagen production, and cell growth.

The VAC therapy actively withdraws this fluid and its constituent

inhibitory factors. Secondly

the VAC therapy reduces the bacterial counts of the wound to a level far lower than what can

cause infection.

Thirdly VAC therapy

improves the entire healing process through its direct

and indirect effects. With removal of local edema, the microcirculation and lymphatic/ venous

drainage is reestablished. The delivery of oxygen and nutrients to the wound is optimized. The

micromechanical forces of

low pressure suction exerts an Ilizarovian effect at cellular level,

resulting

in

increased

expression

of

mRNA

and

protein

synthesis.

There

is

increased

Angiogenesis. The moist environment provided by VAC technique promotes granulation tissue

formation and healing. 4-6

The wound if small is thus encouraged to close spontaneously. Larger

and complex wounds are rendered suitable for definitive reconstruction with skin graft or flap.

How can the VAC therapy be applied to a wound? Not surprisingly

with growing

understanding of the mechanism involved, one can easily construct a VAC dressing at bed side

and

convert an open wound into a close controlled one.

Before its application to the wound,

once

must make sure that wound is first adequately

debrided with excision of all devitalized

tissues. Two sheets of synthetic foam are then tailored the size and shape of the wound and the

wound is covered with them with a

Redivac suction drain placed

between the two sheets.

A

transparent sealing plastic membrane sheet such as Opsite or plastic food wrap is then applied

to the foam layers, making the system water tight and air tight. The suction drain is connected to

Suction machine or wall vacuum suction maintained at 50-120 mmHg. It is maintained for five

days, at which point the VAC dressing is removed.

A fresh VAC dressing may be applied for

another five days and the wound re-evaluated for further definitive management. 1

What kind of wounds are suitable for VAC therapy?

In fact the VAC therapy finds almost

universal applicability across a range of wounds, with only few contraindications such as

malignancy, bleeding diathesis and exposed major blood vessels. When employed, VAC therapy

helps

to

temporize

wounds,

giving

time

for

stabilization

of

the

patient

until

complex

reconstructive procedures can be instituted on a prepared wound bed. It is effective both in the

preparatory phase of wound prior to any

reconstruction and as postoperative dressings for

securing skin grafts especially in wounds on difficult anatomic locations. 1, 7-10

Owing to its low cost, VAC therapy provides an economical alternative to the other available

costly local wound management measures. Such economic implications of wound management

are particularly important in the context of our limited health budgets. It also reduces the need

for daily change of dressing thus comforting the patients on one hand

and reducing the work

load of the

staff responsible for wound dressings on the other hand. With expeditious wound

healing, the overall hospital stay of the patients is also reduced. 1

Given the growing body of quality evidence, VAC therapy should be adequately employed

particularly in the problem wounds and in the problem patients such as those with diabetes

mellitus and peripheral vascular disease. Nonetheless once must not forget that it is an adjunct to

other established

them.

wound care measures such as thorough debridement and not a substitute for

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