View
85
Download
0
Category
Preview:
Citation preview
CONTENTS INTRODUCTION
MECHANISM OF WOUND HEALING
NOVEL CONCEPTS IN WOUND HEALING
VACUUM ASSISSTED CLOSURE WOUND THERAPY
MECHANISM OF ACTION OF VAC
METHODOLOGY
USES OF VAC
ADVANTAGES AND DISADVANTAGES
APPLICATIONS
FUTURE DEVELPOMENT
CONCLUSION
REFERENCES
INTRODUCTION
Wounds may result from trauma or from a surgical incision. In
addition, pressure ulcers (also known as decubitus ulcers or bed
sores), a type of skin ulcer, might also be considered wounds.
Wound healing is the process of repair that follows injury to the
skin and other soft tissues.
The capacity of a wound to heal depends in part on its depth,
as well as on the overall health and nutritional status of the
individual.
Following injury, an inflammatory response occurs and the
cells below the dermis (the deepest skin layer) begin to increase
collagen (connective tissue) production. Later, the epithelial
tissue (the outer skin layer) is regenerated.
Standard wound management consists of:
Initial surgical debridement (a rapid and effective technique to remove devitalised tissue).
Wet-to moist (WM) gauze dressings , which need to be changed at least twice daily.
These dressings are relatively inexpensive, readily available.
Disadvantages: non-selective debridement with dressing removal, possible wound desiccation, and the need for frequent dressing changes.
The vacuum-assisted closure (VAC) device was pioneered by Dr Louis Argenta and Dr Michael Morykwas in 1993.
Vacuum-assisted closure (VAC) therapy-
Alternative to the standard forms of wound management, which incorporates the use of negative pressure to optimise conditions for wound healing and requires fewer painful dressing changes.
NOVEL CONCEPTS IN WOUND HEALINGWound dressing
Dry dressing
Wet-to-dry dressing
Foam dressing
Alginate dressing
Hydro-fibre dresssing
Transparent film dressings
Hydrogel dressing
Hydrocolloid dressing
VACUUM ASSISSTED CLOSURE WOUND THERAPY The application of controlled levels of negative
pressure accelerates debridement and promote healing in many different types of wounds.
The optimum level of negative pressure appears to be around 125 mmHg.
Negative pressure assists;
Removal of interstitial fluid.
Decreases localised oedema.
Increases blood flow.
MECHANISM OF ACTION Promotes granulation tissue
formation . Stimulates localized blood
flow .
Reduces bacterial colonization
Provides moist wound healing environment
Reduces localized edema
Enhances epithelial migration
Applies negative pressure to uniformly draw wound closed (wound contraction)
METHODOLOGYMaterials needed: Scissors (sterile or clean) Gloves (sterile or clean) Dressing kit Canister V.A.C. UnitOptional: Skin prep Tincture Benzoin Non-adherent dressing, such as Mepitel
Aggressively clean wound
Debride necrotic tissue or eschar if possible
Achieve hemostasis
Shave hair around border if needed
Irrigate wound with normal saline
Dry and prep skin as appropriate
Cut foam to size of wound
Gently lay foam in wound, including tunnels,
undermining, and all surfaces
1.Clean wound thoroughly
Aggressive cleaning of the wound at each dressing change is
imperative to decrease bacterial load and minimize odor
Cut foam
Cut the foam to fit the size and shape of the wound, including tunnels and
undermined areas
Lay foam in wound
Gently place the foam into the wound cavity, covering the entire
wound base and sides, tunneling and undermining
Cut the drape
Cut the drape large enough to cover the foam and 3-5 cm of surrounding
healthy tissue with drape.
Applying the drape
Apply the drape beginning on one side of the foam, toward the tubing. Do not
stretch the drape and do not compress the foam into the wound with drape.
This helps minimize tension or shearing forces on periwound tissue
Canister CANISTER WITH ISOLYSER
Canister comes with Isolyser gel that gels fluid on contact and helps
eliminate odor
ADVANTAGESProvides more effective therapy because target sub
atmospheric pressure is monitored and maintained at Maximizes accuracy and effectiveness of V.A.C.® Therapy.
Reduced frequency of dressing changes.
Reduced bacterial cell count.
Enhanced dermal perfusion.
Provision of closed, moist wound healing environment.control of odour and exudate.
Reduction in complexity and number of surgical procedure.
DISADVANTAGES Pain and discomfort when suction is applied initially.
Allergies to adhesive drape.
Noise of vac therapy unit.
If the wound deteriorates after the first dressing change discontinue vac therapy.
Fulminant or incipient skin necrosis.
Excoriation of the skin if foam is not correctly cut to use.
Drain require fixation.
APPLICATIONS
Treatment of early hip joint infections.
Post operative ascetic fluid leaks in cirrhotic patients.
Wound temporation in composite scalp and calvarial
defects.
Sea water-immersed wound treatment under different
negative pressure.
Treatment of perineal war wound related to rectum.
In patients with wound dehiscence after abdominal
open surgery.
Management of Postpneumonectomy Empyema.
Management of lung abscess.
Treatment of mastitis assossiated chronic breast
wounds.
FUTURE DEVELOPMENT Emerging use of VAC therapy in the paediatric
population. Clarification is needed on the type of foam dressing and pressure settings to be used in these patients.
Research is needed to establish the relationship between negative pressure and blood flow and the optimal pressure for wound healing.
As new negative pressure devices are developed, there will be a need to compare the effectiveness of the V.A.C. Therapy system with these emerging systems.
CONCLUSION New tool.
Convert complicated wound into simpler wound.
Improved efficacy
Safety outcomes
Limited cost effectiveness
Fewer painful dressing changes
Smoother transition from hospital to community
REFERENCE Sziklavari Z, Grosser C, Neu R, Schemm R, Kortner A,(
2011) “Complex pleural empyema can be safely treated with vacuum-assisted closure." Cardiothorac Surgery, 6-130.
Labler L, Keel M, Trentz O. (2004) Vacuum-assisted closure (V.A.C.) for temporary coverage of soft-tissue injury in type III open fracture of lower extremities. European Journal of Trauma ; 30(5):305-12.
Hunter JE, Teot L, Horch R, Banwell PE (2007). Evidence based medicine: vacuum assisted closure in wound care management. Wound J ; 4(3): 256-69.
M. J. Morykwas, J. Simpson, K. Punger, A. Argenta, L. Kremers, and J. Argenta,(2006) “Vacuum-assisted closure: state of basic research and physiologic foundation,” Plastic and Reconstructive Surgery, vol. 117, no. 7, pp. 121S–126S.
Palmen M, van Breugel HN, Geskes GG, (1997). Open window thoracostomy treatment of empyema is accelerated by vacuum-assisted closure. Ann ThoracSurg;88:1131-6.
Recommended