Use of vacuum-assisted closure in the topical treatment of surgical site infections

Kilic, Aylan; Özkaya, Ufuk; Sökücü, Sinem Nedime; Basılgan, Seçkin; Kabukçuoğlu, Yavuz

doi:10.3944/aott.2009.336

Cited by 4 publications

(2 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The mean wound area showed a notable threefold reduction. 28 (Level of Evidence: IV) Ploumis reported on 73 consecutive patients with 79 wound infections after spinal surgery in the cervical, thoracic, and lumbar spine. Sixty-nine infections (87.3%) were deep to the fascia; 64 infections (81%) presented with a draining wound within the first 6 weeks postoperatively; six of the infections were reoccurrences.…”

Section: Vacuum-assisted Wound Closure Therapy Mechanism Of Actionmentioning

confidence: 99%

“…VAC therapy can be used in treatment of infected surgical wounds, traumatic wounds, fasciotomy wounds, compartment syndrome, wounds with exposed bone and hardware, pressure ulcers, diabetic foot ulcers, and venous stasis ulcers. 25,28 Although there are many uses for VAC therapy, herein we focus on the use of VAC therapy for DWIs involving the posterior lumbar spine. Surgical débridement requiring a repeat exploration and or delayed closure can benefit from the effects of a VAC in between operations.…”

Section: Indications Contraindications and Complicationsmentioning

confidence: 99%

See 1 more Smart Citation

Vacuum-Assisted Wound Closure Management for Posterior Lumbar Spine Infections

Kim

Carlson

Dawson

et al. 2022

J Am Acad Orthop Surg

View full text Add to dashboard Cite

A postoperative infection involving the tissues deep to the fascia is defined as a deep wound infection (DWI). Management of such infections after lumbar spinal surgery remains a challenge. One strategy is the use of vacuum-assisted wound closure (VAC) which applies negative pressure to the wound to improve microcirculation and to promote the formation of granulation tissue. When combined with antibiotics, VAC has been shown to successfully treat DWIs and is now a common strategy for treating deep postoperative wound infections after spinal surgery. In this article, we review the technique of VAC, its mechanism of action, indications and contraindications, and clinical outcomes in the treatment of DWIs after lumbar spinal surgery.A ccording to the Centers for Disease Control and Prevention, a surgical site infection (SSI) is an infection that "occurs within 30 days after the operation if no implant is left in place or within 1 year if an implant is in place and the infection seems to be related to the operation." 1 Based on more than one hundred thousand procedures, the Scoliosis Research Society Morbidity and Mortality Committee reported the rate of deep SSI (otherwise known as a deep wound infection [DWI]) after lumbar decompression or diskectomy is 0.4% or 1.1%, respectively. More recently, a recent large cohort study reported a 0.49% DWI rate across all surgical pathologies and both decompression only and fusion procedures after implementation of protective measures. The authors recommended chlorohexidine gluconate showers and glucose management, as well as intraoperative and postoperative considerations, to minimize DWI risk. 2 SSIs are associated with both patient-related and procedure-related factors. Patient-related factors include age greater than 60 years, obesity, tobacco use, alcohol abuse, malnourishment, bacteremia, diabetes, chronic obstructive pulmonary disease, coronary heart disease, osteoporosis, neurologic injury, cognitive impairment, prolonged postoperative bed rest, and skin maceration. 3 Procedure-related factors include posterior surgical approach, wound depth greater than 4 cm, use of implants, large blood loss, dural tear, use of allograft, fusion greater than seven levels, revision procedures, fusion to the sacrum, and drainage tubes exiting deeply to the rectum. 3,4 The operating room environment provides additional important risk factors including greater than 10

show abstract

Section: Vacuum-assisted Wound Closure Therapy Mechanism Of Actionmentioning

confidence: 99%

Section: Indications Contraindications and Complicationsmentioning

confidence: 99%

Vacuum-Assisted Wound Closure Management for Posterior Lumbar Spine Infections

Kim

Carlson

Dawson

et al. 2022

J Am Acad Orthop Surg

View full text Add to dashboard Cite

show abstract

EWMA Document: Negative Pressure Wound Therapy

et al. 2017

View full text Add to dashboard Cite

1. Introduction Since its introduction in clinical practice in the early 1990's negative pressure wounds therapy (NPWT) has become widely used in the management of complex wounds in both inpatient and outpatient care. NPWT has been described as a effective treatment for wounds of many different aetiologies and suggested as a gold standard for treatment of wounds such as open abdominal wounds, dehisced sternal wounds following cardiac surgery and as a valuable agent in complex non-healing wounds. Increasingly, NPWT is being applied in the primary and home-care setting, where it is described as having the potential to improve the efficacy of wound management and help reduce the reliance on hospital-based care. While the potential of NPWT is promising and the clinical use of the treatment is widespread, highlevel evidence of its effectiveness and economic benefits remain sparse. The ongoing controversy regarding high-level evidence in wound care in general is well known. There is a consensus that clinical practice should be evidence-based, which can be difficult to achieve due to confusion about the value of the various approaches to wound management; however, we have to rely on the best available evidence. The need to review wound strategies and treatments in order to reduce the burden of care in an efficient way is urgent. If patients at risk of delayed wound healing are identified earlier and aggressive interventions are taken before the wound deteriorates and complications occur, both patient morbidity and health-care costs can be significantly reduced. There is further a fundamental confusion over the best way to evaluate the effectiveness of interventions in this complex patient population. This is illustrated by reviews of the value of various treatment strategies for non-healing wounds, which have highlighted methodological inconsistencies in primary research. This situation is confounded by differences in the advice given by regulatory and reimbursement bodies in various countries regarding both study design and the ways in which results are interpreted. In response to this confusion, the European Wound Management Association (EWMA) has been publishing a number of interdisciplinary documents with the intention of highlighting: The nature and extent of the problem for wound management: from the clinical perspective as well as that of care givers and the patients Evidence-based practice as an integration of clinical expertise with the best available clinical evidence from systematic research The nature and extent of the problem for wound management: from the policy maker and healthcare system perspectives The controversy regarding the value of various approaches to wound management and care is illustrated by the case of NPWT, synonymous with topical negative pressure or vacuum therapy and cited as branded VAC (vacuum-assisted closure) therapy. This is a mode of therapy used to encourage wound healing. It is used as a primary treatment of chronic wounds, in complex acute wounds and as an adjunct for temporary ...

show abstract

Negative pressure wound therapy for management of the surgical incision in orthopaedic surgery

Karlakki

Brem²,

Giannini

et al. 2013

Bone & Joint Research

117

View full text Add to dashboard Cite

ObjectivesThe period of post-operative treatment before surgical wounds are completely closed remains a key window, during which one can apply new technologies that can minimise complications. One such technology is the use of negative pressure wound therapy to manage and accelerate healing of the closed incisional wound (incisional NPWT). MethodsWe undertook a literature review of this emerging indication to identify evidence within orthopaedic surgery and other surgical disciplines. Literature that supports our current understanding of the mechanisms of action was also reviewed in detail. ResultsA total of 33 publications were identified, including nine clinical study reports from orthopaedic surgery; four from cardiothoracic surgery and 12 from studies in abdominal, plastic and vascular disciplines. Most papers (26 of 33) had been published within the past three years. Thus far two randomised controlled trials – one in orthopaedic and one in cardiothoracic surgery – show evidence of reduced incidence of wound healing complications after between three and five days of post-operative NPWT of two- and four-fold, respectively. Investigations show that reduction in haematoma and seroma, accelerated wound healing and increased clearance of oedema are significant mechanisms of action. ConclusionsThere is a rapidly emerging literature on the effect of NPWT on the closed incision. Initiated and confirmed first with a randomised controlled trial in orthopaedic trauma surgery, studies in abdominal, plastic and vascular surgery with high rates of complications have been reported recently. The evidence from single-use NPWT devices is accumulating. There are no large randomised studies yet in reconstructive joint replacement.Cite this article: Bone Joint Res 2013;2:276–84.

show abstract

Use of vacuum-assisted closure in the topical treatment of surgical site infections

Abstract: Besides its topical advantages in the care of infected wounds, vacuum-assisted closure provides a more rapid and comfortable treatment opportunity, representing a reliable alternative to conventional wound care methods.

Cited by 4 publications

References 24 publications

Vacuum-Assisted Wound Closure Management for Posterior Lumbar Spine Infections

Vacuum-Assisted Wound Closure Management for Posterior Lumbar Spine Infections

EWMA Document: Negative Pressure Wound Therapy

Negative pressure wound therapy for management of the surgical incision in orthopaedic surgery

Contact Info

Product

Resources

About