P-78: Vacuum-assisted Closure (VAC) Therapy Applications in a Paediatric Intestinal Rehabilitation Unit

Abstract BACKGROUND AND IMPORTANCE: Since the introduction of vacuum-assisted closure (VAC) in 1997, it has been used successfully in treating difficult wounds, including spinal wounds and wounds in pediatric patients. There are no reports on VAC therapy in pediatric patients on the scalp, especially with exposed dura. This report describes a 10-year-old boy with a chronic wound of the scalp with exposed dura after multiple neurosurgical interventions who was treated successfully with VAC. CLINICAL PRESENTATION: A 10-year-old mentally disabled boy with Apert syndrome suffered from a chronic wound with community-associated methicillin-resistant Staphylococcus aureus (MRSA) infection after multiple neurosurgeon operations. For wound closure, VAC therapy was initiated on the bony defect with exposed dura. The wound healed successfully, and the MRSA disappeared. CONCLUSION: The aims of VAC therapy are formation of new granulation tissue, wound cleansing, and bacterial clearance. In this case, the VAC device was excellent for temporary coverage of the defect and for wound cleaning, and it allowed a thick bed of granulation tissue to form over the dura, even with minimal constant negative pressure. The application and management were feasible even in a mentally disabled child. With this experience, we are encouraged to use the VAC device in difficult wounds, even in the head and neck area in children, and to bring this treatment into the outpatient clinic.

Download Full-text

Evaluation of the effectiveness of vacuum-assisted closure in the treatment of Fournier gangrene

10.31083/jomh.2021.089 ◽

2021 ◽

pp. 1

Keyword(s):

Hospital Stay ◽

Wound Closure ◽

Length Of Hospital Stay ◽

Vacuum Assisted Closure ◽

Analgesic Requirement ◽

Vac Therapy ◽

Fournier Gangrene ◽

Group I ◽

Group Ii ◽

Closure Method

Background and objective: To evaluate the effectiveness of vacuum-assisted closure (VAC) in the treatment of Fournier gangrene (FG). Material and methods: Forty-eight male patients treated for Fournier gangrene were included in the study. The patients were divided into two groups (Group I: conventional dressing, Group II: VAC therapy). Characteristics of the patients, laboratory parameters, number of debridement procedures, daily number of dressings, visual analogue scale (VAS) during dressing, analgesic requirement, colostomy requirement, time from the first debridement to wound closure, wound closure method, length of hospital stay, and mortality rates were compared. Results: Group I comprised 33 patients and Group II comprised 15 patients. The number of dressings, VAS score and daily analgesic requirement were statistically significantly lower in Group II (p < 0.05) than in Group I. The number of debridement procedures, colostomy requirement, orchiectomy rate, time from first debridement to wound closure, length of hospital stay, wound closure method and mortality rate were similar between these two groups (p > 0.05). Conclusion: The clinical results of conventional dressing and VAC therapy were similar for treating FG. VAC therapy is an effective postoperative wound care method that offers less requirement for dressing changes, less pain, less analgesic requirement and more patient satisfaction compared to conventional dressing.

Download Full-text

Vacuum-assisted closure (VAC) for postoperative secondary peritonitis: Effect on bacterial load as well as local and systemic cytokine response (initial results)

Polish Journal of Surgery ◽

10.5604/01.3001.0012.1751 ◽

2018 ◽

Vol 90 (5) ◽

pp. 27-31 ◽

Cited By ~ 3

Author(s):

Olof Jannasch ◽

Frank Meyer ◽

Angela Fuellert ◽

Brigitte König ◽

Frank Eder ◽

...

Keyword(s):

Immune Response ◽

Pilot Study ◽

Peritoneal Fluid ◽

Surgical Intervention ◽

Bacterial Load ◽

Abdominal Cavity ◽

Secondary Peritonitis ◽

Vacuum Assisted Closure ◽

Vac Therapy ◽

Source Of Infection

Background: It is still a matter of debate what the best management of peritonitis is following eliminating the source of infection. This particularly concerns the amplitude of local and systemic inflammatory response as well as bacterial clearence at the infectious site. Aim: To investigate the effects of vacuum-assisted closure (VAC) vs. relaparotomy on demand (ROD) onto the i) severity and course of disease, ii) surgical outcome, iii) intraperitoneal bacterial load as well as iv) local and systemic inflammatory and immune response in postoperative secondary peritonitis. Methods: Over a defined time period, all consecutive patients of the reporting surgical department with a secondary peritonitis (assessed by Mannheim’s Peritonitis Index [MPI] and APPACHE II score) were enrolled in this systematic unicenter clinical prospective observational pilot study reflecting daily surgical practice and as a contribution to internal quality assurance. Patients were subclassified into VAC or ROD group according to surgeon’s individual decision at the time point of primary surgical intervention with the intent to sanitize the source of infection. Early postoperative result was assessed by 30-d and in-hospital mortality. Bacterial load was characterized by microbiological culture of intraperitoneal fluid collection obtained on postoperative days (POD) 0 (primary surgical intervention), 1, 4, 7, 10, 13 and following description of the microbial spectrum including semiquantitative assessment of bacterial load. Local and systemic inflammatory and immune response was determined by ELISA-based analysis of CrP, PCT and the representative cytokines such as TNF-α, IL-1β, IL-6, IL-8, and IL-10 of serum and peritoneal fluid samples. Results: Over a 26-months investigation period, 18 patients (sex ratio, male:female=9:9) were eligible for study criteria: n=8 were enrolled in the VAC (m:f=4:4) and n=10 in the ROD group (m:f=5:5). With regard to early postoperative results represented by mortality, there is no significant difference between both patients groups. Despite the relatively low number of cases enrolled in this study, a trend for more severe findings associated with the VAC group could be detected based on MPI score. There was also a trend of higher APACHE II scores in the VAC group from the 7th POD on and, in addition, patients of this group had a longer hospital stay. For patients with persisting infection, there were no relevant differences comparing VAC therapy and ROD. Cytokines released, in particular, at the beginning of the inflammation cascade with proinflammatory characteristics, showed higher values within the peritoneal fluid whereas CrP and PCT were found to be higher within the serum samples. Summary & Conclusion: Comparing data of various local and systemic inflammatory and immune parameters, there were only a few correlations. This may indicate a compartimentation of the inflammatory process within the abdominal cavity. Based on the observed inter-individual variation of this pilot study data, the clinically applicable benefit appears questionable. In this context, a reliable effect of VAC therapy onto reduction of bacterial burden within the abdominal cavity could not clearly be detected.

Download Full-text

Successful bridging treatment and healing of enteric fistulae by vacuum-assisted closure (VAC) therapy and targeted drainage in patients with open abdomen

International Journal of Colorectal Disease ◽

10.1007/s00384-010-1126-z ◽

2011 ◽

Vol 26 (5) ◽

pp. 661-666 ◽

Cited By ~ 7

Author(s):

Stefan Stremitzer ◽

Andrea Dal Borgo ◽

Thomas Wild ◽

Peter Goetzinger

Keyword(s):

Open Abdomen ◽

Vacuum Assisted Closure ◽

Vac Therapy

Download Full-text

PS02.028: RESULTS OF ENDOSCOPIC VACCUM-ASSISTED CLOSURE THERAPY IN THE MANAGEMENT OF POSTOPERATIVE LEAKAGE AFTER ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.028 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 128-128

Author(s):

Jae Hyun Jeon ◽

Kwhanmien Kim ◽

Yong Won Seong ◽

Sukki Cho ◽

Sanghoon Jheon

Keyword(s):

Conflicts Of Interest ◽

Therapeutic Option ◽

Oral Feeding ◽

Vacuum Assisted Closure ◽

Vac Therapy ◽

Effective Therapeutic Option ◽

Significant Life ◽

Life Threatening ◽

New Treatment ◽

Postoperative Leakage

Abstract Background Postoperative leakage after esophagectomy is associated with significant life-threatening complications. Recently, endoscopic vacuum-assisted closure (E-VAC) has been introduced and successfully used as a new treatment option. The purpose of this study was to evaluate the safety and efficacy of the E-VAC for the management of postoperative leakage. Methods A total of 22 patients were treated with either intraluminal or intracavitary E-VAC therapy for the management of postoperative leakage from May 2012 to April 2018. The location of leakage was intrathoracic in 17 patients, and cervical in 5. The size of defects was small (< 1 cm) in 8 patients, moderate (1∼2 cm) in 6, and large (> 2 cm) in 5. Outcomes of E-VAC therapy were analyzed retrospectively. Results Complete closure of postoperative leakage was achieved in 19 of 22 patients. The location and size of defects did not affect the success of VAC therapy (all P < 0.05, respectively). The median duration of E-VAC application was 14 days (range 2∼103), and a median of 3 E-VAC systems (range, 1∼14) were used. In 19 patients who were successfully treated with E-VAC, oral feeding was possible on median 15 days after the first day of treatment. There was no mortality related with postoperative leakage. Conclusion E-VAC might be a well-tolerated and effective therapeutic option for the treatment of various postoperative leakage after esophagectomy. Disclosure All authors have declared no conflicts of interest.

Download Full-text

Endoluminal Vacuum Assisted Closure (E-Vac) Therapy for Postoperative Esophageal Fistula: Successful Case Series and Literature Review

10.21203/rs.3.rs-34105/v1 ◽

2020 ◽

Author(s):

Carolina Rubicondo ◽

Andrea Lovece ◽

Domenico Pinelli ◽

Amedeo Indriolo ◽

Alessandro Lucianetti ◽

...

Keyword(s):

Gastrointestinal Tract ◽

Case Series ◽

High Rate ◽

Upper Gastrointestinal Tract ◽

Vacuum Assisted Closure ◽

Vac Therapy ◽

Esophageal Lumen ◽

Esophageal Perforations ◽

Esophagectomy For Cancer ◽

Upper Gastrointestinal

Abstract Background: Treatment of esophageal perforations and postoperative anastomotic leaks of the upper gastrointestinal tract remains a challenge. Endoluminal vacuuma assisted closure (E-vac) therapy has positively contributed, in recent years, to the management of upper gastrointestinal tract perforations by using the same principle of vacuum assisted closure therapy of external wounds. The aim is to provide continuous wound drainage and to promote tissue granulation, decreasing the needed time to heal with a high rate of leakage closure.Report of cases: A series of two different cases with clinical and radiological diagnosis of esophageal fistulas, recorded during the 2018 to 2019 period at our institution, is presented. The first one is a case of anastomotic leak after esophagectomy for cancer complicated by pleuro-mediastinal abscess; while the second one is a leak of an esophageal suture, few days after resection of a bronchogenic cyst perforated into the esophageal lumen. Both cases were successfully treated with E-vac therapy.Conclusion: Our results confirm the usefulness of E-vac therapy in the management of anastomotic and non-anastomotic esophageal fistulas. Further research is needed to better define its indications, to compare it to traditional treatments and to evaluate its long-term efficacy.

Download Full-text

Vacuum-Assisted Closure to Aid Wound Healing in Foot and Ankle Surgery

Foot & Ankle International ◽

10.1177/107110070502600915 ◽

2005 ◽

Vol 26 (9) ◽

pp. 761-766 ◽

Cited By ~ 33

Author(s):

Derick A. Mendonca ◽

Tom Cosker ◽

Nilesh K. Makwana

Keyword(s):

Vascular Disease ◽

Peripheral Vascular Disease ◽

Wound Closure ◽

Wound Dehiscence ◽

Foot And Ankle ◽

Class Iii ◽

Peripheral Vascular ◽

Vacuum Assisted Closure ◽

Vac Therapy ◽

Ankle Surgery

Background: Although vacuum-assisted closure (VAC) is a well-established technique in other surgical specialties, its use has not been established in the foot and ankle. The aims of this study were to determine if vacuum-assisted closure therapy (VAC) helps assist closure in diabetic foot ulcers and wounds secondary to peripheral vascular disease, if it helps debride wounds, and if it prevents the need for further surgery. Methods: We retrospectively reviewed 15 patients (18 wounds or ulcers) with primary diagnoses of diabetes (10 patients), chronic osteomyelitis (two patients), peripheral vascular disease (two patients), and spina bifida (one patient). Eleven of the 15 patients had serious comorbidities, such as peripheral neuropathy, renal failure, and wound dehiscence. All wounds were surgically debrided before VAC therapy was applied according to the manufacturer's instructions. The main outcome measures were time to satisfactory wound closure, changes in the wound surface area, and the need for further surgery. Results: Satisfactory healing was achieved in 13 of the 18 wounds or ulcers at an average of 2.5 months. VAC therapy failed in five patients (five class III ulcers), three of whom required below-knee amputations. Wound or ulcer size decreased from an average of 7.41 cm 2 before treatment to an average of 1.58 cm 2 after treatment. Conclusion: VAC therapy is a useful adjunct to the standard treatment of chronic wound or ulcers in patients with diabetes or peripheral vascular disease. Its use in foot and ankle surgery leads to a quicker wound closure and, in most patients, avoids the need for further surgery.

Download Full-text

Therapeutic efficacy of vacuum-assisted-closure therapy in the treatment of lymphatic complications following peripheral vascular interventions and surgeries

Vascular ◽

10.1177/1708538114529950 ◽

2014 ◽

Vol 23 (1) ◽

pp. 41-46 ◽

Cited By ~ 7

Author(s):

Ufuk Aydin ◽

Alper Gorur ◽

Orhan Findik ◽

Abdullah Yildirim ◽

Cevdet Ugur Kocogullari

Keyword(s):

Primary Therapy ◽

Peripheral Vascular ◽

Vacuum Assisted Closure ◽

Vascular Intervention ◽

Vac Therapy ◽

Group I ◽

First Choice ◽

Peripheral Vascular Intervention ◽

The Mean ◽

Lymphatic Complications

Objectives Lymphatic complications, lymphocele and lymphorrhea being the leading, are generally encountered after vascular interventions and surgeries. The present study aimed to evaluate the outcomes of vacuum-assisted-closure (VAC) therapy, which we frequently prefer as the first-choice treatment for such complications. Materials and methods Among patients undergoing peripheral vascular intervention or surgery between January 2008 and February 2012, the medical files of 21 patients who received VAC therapy or other treatment due to symptomatic lymphatic complications were retrospectively analyzed and the results were discussed. Results Group I consisted of 10 patients (three with lymphocele and seven with lymphorrhea) who underwent VAC therapy as the first-choice treatment, Group II consisted of 11 patients of which 7 patients received various therapies before VAC therapy and 4 patients received other treatments alone. The patients who received VAC therapy as the primary therapy demonstrated more rapid wound healing, early drainage control, and shorter hospital stay. The mean hospital medical cost was €1038 (range, €739–1826) for the patients who primarily underwent VAC therapy; it was calculated to be €2137 (range, €1610–3130) for the other patients ( p = 0.001). Conclusion In addition to its safety and good clinical outcomes, VAC therapy also has economic advantages and should be the primary method for the treatment of lymphatic complications.

Download Full-text

The Use of Vacuum-Assisted Closure Therapy for the Treatment of a Large Infected Facial Wound

The American Surgeon ◽

10.1177/000313480607200206 ◽

2006 ◽

Vol 72 (2) ◽

pp. 129-131 ◽

Cited By ~ 2

Author(s):

Rob Schuster ◽

Arash Moradzadeh ◽

Kenneth Waxman

Keyword(s):

Health Care Providers ◽

Granulation Tissue ◽

Chronic Wounds ◽

Care Providers ◽

Vacuum Assisted Closure ◽

Vac Therapy ◽

First Case ◽

Facial Wound ◽

The Face ◽

New Treatment

Chronic wounds in difficult locations pose constant challenges to health care providers. Negative-pressure wound therapy is a relatively new treatment to promote wound healing. Laboratory and clinical studies have shown that the vacuum-assisted closure (VAC) therapy increases wound blood flow, granulation tissue formation, and decreases accumulation of fluid and bacteria. VAC therapy has been shown to hasten wound closure and formation of granulation tissue in a variety of settings. Accepted indications for VAC therapy include the infected sternum, open abdomen, chronic, nonhealing extremity wounds and decubitus ulcers. We report the first case of VAC therapy successfully used on a large infected wound to the face to promote healing.

Download Full-text