Vacuum sealing is a new therapeutic concept to achieve secure and rapid wound healing in traumatic soft tissue damage (incl.open and closed fractures), in acute and, as an intermediate measure, in chronic infections. The tissue defect is filled in with open-porous polyvinylalcohol-foam and the entire wound surface is covered with a semipermeable transparent Polyurethane drape. Using Redon-drainage tubes and vacuum bottles, a vacuum of 80 kPa is established in the entire wound. This results in a complete evacuation of fluids and a high pressure in the interface between the foam and the wound surface without compression of deeper wound layers. The therapeutic benefit lies in the rapid formation of sound granulation tissue. Between January 1992 and August 1993, 181 patients had undergone a vacuum sealing procedure. 121 patients were followed up, underlining the benefit of vacuum sealing for the treatment of soft tissue defects.
A wide variety of silver-impregnated wound dressings has become available in recent years. This has given the practitioner choice but little evidence by which an appropriate dressing may be selected. In many instances, the ancillary function(s) of the dressing will become differentiating factors that influence choice. For example, the dressing capacity to manage exudate, maintain an optimum moist environment, reduce or avoid maceration, maintain an intimate contact with the wound bed, promote autolytic debridement, sequester bacteria and bind matrix metallo proteases (MMPs) are some of those functions that are of clinical significance and may dictate choice. In this article we present the evidence for these functions, thereby enabling practitioners to evaluate comparative dressing attributes, and so make an informed choice of which silver dressing best suits the needs of the wound under differing circumstances.
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