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TMP ECB3
TMP ECB3
Muhammad Saaiq
Editorial
Muhammad Saaiq
VAC Therapy: A Valuable Adjunct Assistant Professor
Plastic surgery and Burn Care
to Wound Care Armamentarium Centre, PIMS, Islamabad.
E-mail
muhammadsaaiq5@gmail.com
Medicine is an ever evolving science. The present day Before its application to the wound, once must make
medicine is termed as evidence based medicine sure that wound is first adequately debrided with
wherein practice and policies are guided by sound excision of all devitalized tissues. Two sheets of
clinical and experimental evidence supporting the synthetic foam are then tailored the size and shape of
benefits and safety of a given therapeutic modality. Over the wound and the wound is covered with them with a
the last decade, Vacuum Assisted Closure therapy Redivac suction drain placed between the two sheets.
(VAC therapy) has emerged as a novel adjunct to the A transparent sealing plastic membrane sheet such as
management of surgical wounds across a range of Opsite or plastic food wrap is then applied to the foam
specialties. 1-3 layers, making the system water tight and air tight. The
suction drain is connected to Suction machine or wall
How does the VAC therapy work? vacuum suction maintained at 50-120 mmHg. It is
Since the technique is relatively new, its exact maintained for five days, at which point the VAC
mechanism of action still continues to be researched. A dressing is removed. A fresh VAC dressing may be
variety of interrelated factors have been identified to applied for another five days and the wound re-
account for its favorable effects on wound healing. evaluated for further definitive management. 1
These factors can be summarized into three subgroups
i.e. removing, reducing and Improving. Firstly the What kind of wounds are suitable for
edematous tissue planes surrounding the wound are VAC therapy? In fact the VAC therapy finds
characterized by localized collection of interstitial fluid almost universal applicability across a range of wounds,
that contains inhibitory factors that suppress mitosis, with only few contraindications such as malignancy,
fibroblasts activity, collagen production, and cell growth. bleeding diathesis and exposed major blood vessels.
The VAC therapy actively withdraws this fluid and its When employed, VAC therapy helps to temporize
constituent inhibitory factors. Secondly the VAC wounds, giving time for stabilization of the patient until
therapy reduces the bacterial counts of the wound to a complex reconstructive procedures can be instituted on
level far lower than what can cause infection. Thirdly a prepared wound bed. It is effective both in the
VAC therapy improves the entire healing process preparatory phase of wound prior to any reconstruction
through its direct and indirect effects. With removal of and as postoperative dressings for securing skin grafts
local edema, the microcirculation and lymphatic/ venous especially in wounds on difficult anatomic locations. 1, 7-10
drainage is reestablished. The delivery of oxygen and Owing to its low cost, VAC therapy provides an
nutrients to the wound is optimized. The economical alternative to the other available costly local
micromechanical forces of low pressure suction exerts wound management measures. Such economic
an Ilizarovian effect at cellular level, resulting in implications of wound management are particularly
increased expression of mRNA and protein synthesis. important in the context of our limited health budgets. It
There is increased Angiogenesis. The moist also reduces the need for daily change of dressing thus
environment provided by VAC technique promotes comforting the patients on one hand and reducing the
granulation tissue formation and healing. 4-6 The wound work load of the staff responsible for wound dressings
if small is thus encouraged to close spontaneously. on the other hand. With expeditious wound healing, the
Larger and complex wounds are rendered suitable for overall hospital stay of the patients is also reduced. 1
definitive reconstruction with skin graft or flap.
Given the growing body of quality evidence, VAC
How can the VAC therapy be applied therapy should be adequately employed particularly in
the problem wounds and in the problem patients such
to a wound? Not surprisingly with growing as those with diabetes mellitus and peripheral vascular
understanding of the mechanism involved, one can disease. Nonetheless once must not forget that it is an
easily construct a VAC dressing at bed side and adjunct to other established wound care measures such
convert an open wound into a close controlled one. as thorough debridement and not a substitute for them.
1.