Vacuum assisted closure: recommendations for use. A consensus document.

FOREWORD This timely initiative draws on both the research evidence and the consensus opinion of an international group of experts (see below) to provide guidance on the successful integration of vacuum assisted closure therapy (V.A.C. ® Therapy) into clinical practice. The document specifically reviews its potential use in the following selected indications*: diabetic foot ulcers, complex leg ulcers, pressure ulcers, dehisced sternal wounds, open abdominal wounds and traumatic wounds. In addition, it considers quality of life and cost-effectiveness, both of which are gaining importance when evaluating treatment. This document highlights questions for future research and is designed to be practical and adaptable for local use in countries worldwide. Supported by an unrestricted educational grant from KCI Europe Holding BV. The views expressed in this document do not necessarily reflect those of KCI. * This document provides recommendations for the use of VAC therapy in six selected wound types. It should be noted, however, that VAC therapy has a role in other wound types, which are not included in this document. Vacuum assisted closure (VAC) therapy has helped to improve wound care outcomes and has led to a number of dramatic changes in clinical practice over the past decade 1,2. VAC therapy must be used as part of an individualised, comprehensive treatment plan and is indicated for both acute and chronic wounds. PLANNING TREATMENT In all situations the underlying wound aetiology and comorbidities must first be addressed and treated. It is essential to optimise all aspects of the patient's physical, nutritional and psychosocial wellbeing to ensure treatment is suitable and of maximum benefit. Before starting VAC therapy it is important to define treatment aims, objectives and clinical endpoints 1. In some circumstances the objective will be to avoid further complications and to control symptoms, rather than to influence time to healing. Examples of clinical endpoints for VAC therapy include 50% volume reduction 3 , 80% granulation tissue formation or complete closure. In general, the key aims are to: ■ remove exudate and reduce periwound oedema ■ increase local microvascular blood flow/test vascularity ■ promote formation of granulation tissue ■ reduce complexity/size of the wound ■ optimise the wound bed prior to and following surgery ■ reduce complexity of surgical wound closure procedures 4. In addition, the application of the VAC dressing system creates a closed, moist wound environment, which may act as a barrier to bacteria and patient/caregiver interference. VAC therapy …