VACUUM ASSISTED CLOSURE (V.A.C.) THERAPY: Mr. Ismazizi Zaharudin Jabatan pembedahan Am Hospital Kuala Lumpur

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1 VACUUM ASSISTED CLOSURE (V.A.C.) THERAPY: Mr. Ismazizi Zaharudin Jabatan pembedahan Am Hospital Kuala Lumpur

2 Learning Objectives Define Negative Pressure Wound Therapy (NPWT) Discuss guidelines for the appropriate use of NPWT Identify patients with wounds who would benefit from NPWT and patients for who this modality would be contraindicated. Discuss guidelines for the application of NPWT. Explain the basic steps in obtaining insurance reimbursement for NPWT in the home care setting.

3 V.A.C. Therapy a.k.a. NPWT NPWT applies continuous or intermittent sub-atmospheric pressure, or suction, to the wound bed via a computerized vacuum pump attached to an open-cell foam sponge that is placed in the wound and secured with an adhesive semi-occlusive dressing. Wound fluids are evacuated via a tubing system placed on the foam at one end and connected to a disposable canister housed in the therapy unit on the opposite end.

4 The V.A.C. System Manufactured by Kinetic Concepts, Inc., San Antonio, TX.

5 Clinical Benefits of V.A.C. Therapy Maintenance of moist, protected environment Removal of excess interstitial fluid from the wound periphery Increased local vascularity Decreased bacterial colonization Quantification/qualification of wound drainage Increased rate of granulation tissue formation Increased rate of contraction Increased rate of epithelialization

6 V.A.C. Therapy Indications Acute wounds Full-thickness surgical wounds Chronic wounds Stage 3 pressure ulcers Stage 4 pressure ulcers Diabetic ulcers Venous stasis ulcers Traumatic wounds Dehisced wounds

7 Stage 3 Pressure Ulcer Full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to (but not through) the underlying fascia. The ulcer presents clinically as a deep crater with or without undermining adjacent tissue. Kinetic Concepts, Inc.

8 Stage 4 Pressure Ulcer Full thickness skin loss with extensive destruction; tissue necrosis; or damage to muscle, bone or supporting structures (e.g. tendon, joint capsule). Note: Undermining and sinus tracts may also be associated with Stage IV pressure ulcers. Kinetic Concepts, Inc.

9 Venous Stasis Ulcer Ulceration associated with venous hypertension Johns Hopkins Medical Images

10 Diabetic Foot Ulcer Diabetics are prone to foot ulcerations due to both neurologic and vascular complications Wound Care Information Network

11 V.A.C. Therapy Precautions Acute bleeding, patients on anticoagulants, or difficult wound homeostasis. Ensure all vessels are adequately protected with overlying fascia, tissue, or other protective barrier. Greater care should be taken with respect to weakened, irradiated, or sutured blood vessels.

12 V.A.C. Therapy Contraindications Malignancy in wound Necrotic tissue with eschar Untreated osteomyelitis Fistulas to organs or body cavities Do not place V.A.C. dressing over exposed arteries or veins

13 Clinical Efficacy 300 wounds treated (acute, subacute, and chronic) 296 wounds improved with an rate of granulation tissue formation Wounds were treated until completely closed, split-thickness skin graft applied, or flap rotated Annals of Plastic Surgery, 1997

14 Cost Effectiveness of V.A.C. Therapy Retrospective chart review of 1032 Medicare home care patients 61% faster healing rate 38% less cost Ostomy/Wound Management, 1999

15 APN Orders for V.A.C. Therapy Location of wound Size of foam dressing (S, M, L, XL) V.A.C. Therapy setting (usually 125 mm Hg continuously or intermittently 5 min on/2 min off) Frequency of dressing changes usually every 48 hours

16 Application of the V.A.C. Visiting Nurse Home caregivers and patients able to apply and remove V.A.C.

17 Dressing Application Overview Place foam in wound Cover with semiocclusive dressing Secure tubing Connect tubing to the V.A.C. therapy unit

18 Operating the V.A.C. Unit Insert canister securely in unit Connect dressing tubing to canister tubing Press power button ON Follow prompts Start therapy Therapy should be on 24 hours each day

19 Alarms Therapy OFF Canister is full Air leak

20 Monitoring and Progression of Wound Healing Weekly wound measurements Signs of healing Oozing of blood as granulation occurs Wound bed becomes redder Gradual in wound drainage in dimensions of wound Average length of treatment is 4-6 weeks

21 Ambulatory Options For the patient who is goes to work or school, a battery powered model is available. Wound must be minimally draining.

22 Termination of V.A.C. Therapy Adequate granulation base achieved allowing for: Changing to conventional dressing changes Split-thickness skin graft Flap closure

23 Additional Information WOUNDVAC V.A.C. Recommended Guidelines for Use: Physician and Caregiver Reference Manual (Kinetic Concepts, Inc.)

24 Key Points Non-invasive active therapy for wound healing Indicated to treat a variety of acute & chronic wounds Dressing changes every 48 hours Reimbursable under Medicare B & most private insurers