Wound Vac

- Vacuum Assisted Closure Device: (Company Web Site)
     - contents:
            - reticulated polyurethane sponge which comes in three sizes along with two transparent plastic self-adhesive sheets;
     - technique:
            - debride all devitalized tissue and contaminated material;
            - sterile reticulated polyurethane sponge is cut to conform with the surface of the wound;
                  - ensure that the deepest portions of the wound are in contact with the sponge;
            - spone makes contact with the entire wound surface;
            - fenestrated end of the tube is placed on surface of sponge;
            - adhesive plastic sheet is applied over the skin, sponge, and around the tubing (sealing the vacuum);
            - egress tube runs from the sponge to VAC pump device;
            - vacuum can be set from neg 50 to neg 200 mm Hg;
            - continuous setting of 125 mm Hg is most common;
            - sponge is changed every 48 hours (except for skin grafts in which sponge is removed at day 4);

- Additional Considerations:
     - Flaps and Reconstructive Techniques:
     - Wound Bullet

- References:
    - basic science:
         - Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation.
         - Bacterial load in relation to vacuum-assisted closure wound therapy: a prospective randomized trial.
         - Quantifying bacterial bioburden during negative pressure wound therapy: does the wound VAC enhance bacterial clearance? 

    - wound vac therapy in diabetes: (see diabetes)
         - Experience with the vacuum assisted closure negative pressure technique in the treatment of non-healing diabetic and dysvascular wounds. 

    - wound vac therapy for STSG: (see STSG)
         - The vacuum assisted closure device: a method of securing skin grafts and improving graft survival.
         - Ambulant vacuum-assisted closure of skin-graft dressing in the lower limbs using a portable mini-VAC device. 

    - extremity trauma and open fractures: (see open fractures)
         - The use of a subatmospheric pressure dressing to salvage a Gustilo grade IIIB open tibial fracture with concomitant osteomyelitis to avert a free flap.
         - The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone.
         - Vacuum-Assisted Wound Closure (VAC Therapy) for the Management of Patients With High-Energy Soft Tissue Injuries.
         - The use of subatmospheric pressure dressing for the coverage of radial forearm free flap donor-site exposed tendon complications.
         - Vacuum-assisted complex wound closure with elastic vessel loop augmentation: a novel technique.
         - The VAC as bridging between primary osteosynthesis in conjunction with functional reconstructed of soft tissue - open frx type 2 and type 3.
         - Experience With Wound VAC and Delayed Primary Closure of Contaminated Soft Tissue Injuries in Iraq. 
         - Negative pressure wound therapy after severe open fractures: a prospective randomized study. 

   - complications of wound vac therapy in orthopaedics:
         - Vacuum-assisted closure complicated by erosion and hemorrhage of the anterior tibial artery. 

   - use over surgical incisions:
         - Negative pressure wound therapy to treat hematomas and surgical incisions following high-energy trauma.

- Misc Ref:
Comparison between intermittent (spring-loaded) and continuous closed suction drainage of orthopedic wounds: a controlled clinical trial.