V.A.C. THERAPY IN GENERAL SURGERY – INITIAL EXPERIENCE

V. Mutafchiyski

Military Medical Academy – Sofia, Bulgaria

Introduction

Since its introduction, V.A.C.® Therapy has

changed the way wounds are healed

V.A.C. Therapy has been selected as the

treatment of choice for more

than 3,000,000 people worldwide

The V.A.C. Therapy System

is comprised of three essential components

that actively work together to help promote

wound healing through granulation tissue formation:

1. V.A.C. Therapy Unit - provides intermittent and continuous therapy with integrated patient safety features

2. Sensa T.R.A.C. Technology - regulates pressure at the wound site to provide accurate delivery of prescribed therapy settings

3. V.A.C. GranuFoamTM Dressings - help provide the necessary mechanisms to promote granulation tissue formation

V.A.C. Therapy - Mechanisms of Action

Wound Healing Barrier V.A.C. Therapy Mechanism

Excess bacterial burden Removes infectious materials

Inadequate protection against infection Provides protected wound healing environment

Excess exudates Removes exudates

Excess edema (interstitial fluid) Reduces edema (interstitial fluid)

Absence of moisture Provides a moist wound healing environment

Lack of adequate blood flow Promotes perfusion

Lack of granulation tissue formation Removes barriers to cell migration and proliferation

Indications Traumatic wounds Complicated wounds High risk wounds Chronic and non-healing wounds Diabetic wounds Decubitus Fistulas Skin grafts, burns

Clinical case 1 36 years old soldier injured in Kandahar

(Afghanistan) Penetrating wound in left femoral region with

damage of v.saphena magna sin, scrotum, fracture of the pubic bone and left gluteus

Clinical case 1

Clinical case 1

Interval between procedures

48 hs

Pressure GranuFoam continuous-125 mmHg

Number of procedures

15

Clinical case 1

Clinical case 1

Clinical case 1

Clinical case 2

26 years old female

Penetrating wound of the abdomen

Injury of the colon, duodenum, stomach, IVC,

right kidney

Severe peritonitis with multiple revisions of the

abdomen

Suppuration of the wound

Clinical case 2Dinamic closure of the abdomen

Clinical case 2

Interval of procedures

48 hrs

Pressure GranuFoam continuous-125 mmHg

Number of procedures

2

Clinical case 3

34 years old male

Gun shot injury in the sacral region

Injury of sacral bone, rectum,

bladder, small intestine, left urether

Hemorrhagic shock

Clinical case 3

Clinical case 3

Clinical case 3

… 48 hours later …

Clinical case 3

Clinical case 3

Clinical case 3

Clinical case 3

Clinical case 3

48 hours later …

Clinical case 3

42 years old male Crush syndrome Pelvic fracture Hemorrhagic shock Angiographic embolization

Clinical case 4

Clinical case 4

Clinical case 4

Clinical case 4

Clinical case 4

Clinical case 4

Clinical case 4

Clinical case 4

Clinical case 4

Clinical case 4

Clinical case 565 years old femaleChronic diabetic wound (5 years)Failure of CONV therapy

Clinical case 5

Clinical case 5

Clinical case 6

22 years old male

Crohn’s disease

Abscess of the right psoas muscle

penetrating into femoral canal

Right hemicolectomy Evacuation of the

abscess Contra-incition

Clinical case 6

Clinical case 6Interval between

procedures 48 hrs

Pressure GranuFoam continuous-125 mmHg

Number of procedures - 2

Clinical case 7

38 years old female

Diasthasis of the abdominal rectal muscles

Three consecutive child- births

Clinical case 7

Clinical case 7

Clinical case 7

Clinical case 8

55 years old male24 days after liver transplantation for HBV

Clinical case 8

Clinical case 8

Clinical case 9Pancreatic cancerMechanic jaundice Purulent cholangitisPostoperative suppuration of the wound

Clinical case 10

High risk wounds

Conclusion

Treatment with the VAC system:

effective in complicated traumatic patient

has a low infection recurrence rate

Improved quality of life

Has a short therapy duration and yields a high

cost efficacy

Thank you