The effectiveness of topical negative pressure in the treatment of pressure ulcers: a literature review


The objective of the study was to gain insight into the effectiveness of vacuum-assisted closure (VAC) therapy or, more particularly, topical negative pressure (TNP) in the treatment of pressure ulcers. We carried out a systematic search in Medline, Embase and Cinahl for Randomized Clinical Trials (RCTs) involving topical negative pressure in pressure ulcers over the period 1992–2007. Five RCTs were included. Two studies dealt exclusively with pressure ulcers. No significant differences in wound healing were found in these studies. Three other studies (mixed etiology of wounds) did show significant differences in wound healing, in the decrease of wound treatment time, and in the decrease in number of bacteria. The quality of these studies, both in terms of methodology and otherwise, did not always match with the scientific standard. Moreover, these studies lacked subgroup analyses. The analyzed studies described positive effects of TNP, although both the control treatment and the end points varied in these studies. On the basis of the systematic assessment of these five RCTs, the conclusion is that TNP has not proven to be more effective than various control interventions. The differences between and within the studies in terms of control interventions, the differences in randomization and a number of weaknesses in the analyses do not allow a good comparison. The main rec-ommendations for follow-up studies include: randomization of patients rather than of wounds, a homogeneous patient population, the use of a single well-defined and procedurally documented control intervention, and prior calculation of the random sample size.

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Poststernotomy aspergillosis

The concept of negative pressure wound therapy (NPWT) after ‎poststernotomy mediastinitis – a single center experience with ‎‎54 patients‎


Deep sternal infections, also known as poststernotomy mediastinitis, are a rare but often fatal complication in cardiac surgery. They are a cause of increased morbidity and mortality and have a significant socioeconomic aspect concerning the health system. Negative pressure wound therapy (NPWT) followed by muscular pectoralis plasty is a quite new technique for the treatment of mediastinitis after sternotomy. Although it could be demonstrated that this technique is at least as safe and reliable as other techniques for the therapy of deep sternal infections, complications are not absent. We report about our experiences and complications using this therapy in a set of 54 patients out of 3668 patients undergoing cardiac surgery in our institution between January 2005 and April 2007.

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The clinical efficacy of the vacuum-assisted closure therapy in ‎the management of adult osteomyelitis

Received: 9 April 2010 / Published online: 23 December 2010 Springer-Verlag 2010


Introduction Vacuum-assisted closure (VAC) therapy is a sophisticated development of a standard surgical procedure. The purpose of this study is to evaluate the clinical efficacy of managing adult osteomyelitis with VAC therapy.

Materials and methods We included a total of 68 patients that developed osteomyelitis with Cierny–Mader types 2, 3 and 4, and required open wound management between March 2005 and February 2009. In this study, 35 of these patients were treated by VAC therapy and the other 33 by conventional wound management. The patients were well compared with type, debridement times, wounds coverage, bacteriology and recurrence.

Results Of the study, the patients treated by VAC therapy had a significantly reduced recurrence (1 vs. 7 wounds, P \ 0.05), decreased rate of further autodermoplasty or flap surgery (17 vs. 26 wounds, P \ 0.05), and increased cases of bacterial species cultures to negative (29 vs. 15 wounds, P \ 0.05), debridement times and type were similar between the two groups.

Conclusion VAC therapy represents a good clinical effi-cacy in treating osteomyelitis; it can promote the granu-lation tissue formation, bacterial clearance, and reduce the needs for tissue transfer and muscle flaps in patients. In addition, it could be used as an adjuvant for the eradication of osteomyelitis and improving soft-tissue management, it may be more suitable for treating osteomyelitis with soft-tissue problems.

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Successful bridging treatment and healing of enteric fistulae by ‎vacuum-assisted closure (VAC) therapy and targeted drainage ‎in patients with open abdomen


Purpose The object of this study was to investigate the bridging treatment of enteric fistulae by vacuum-assisted closure (VAC) therapy in patients with open abdomen.

Methods We retrospectively analyzed patients who have been treated between 1 January 2007 and 31 December 2008 at the intensive care unit of the Department of General Surgery, Medical University Vienna. Control of the fistula was established by VAC therapy to bridge the patients to the time of the fistula resection.

Results In the period of investigation, we treated nine (six men/three women) patients suffering from enteric fistulae with VAC therapy. The median age of the patients was 48 (range, 37–67) years. The median duration of VAC therapy was 76 (range, 53–128) days. The median length of stay in the intensive care unit was 44 (range, 25–127) days. The median APACHE II score was 23 (range, 18–25). The predicted mortality was 40%; the actual mortality was 11% (one patient). Primary fascial closure was achieved after median 91 (range, 89–92) days in three patients (33%) and secondary fascial closure after median 292 (range, 252– 546) days in another three patients (33%). Fistulae were cured with VAC (five patients, 56%) and surgical resection (three patients, 33%). None of the patients developed a refistulation at the time of follow-up.

Conclusions Control of enteric fistulae by VAC therapy can lead to spontaneous fistula closure and is associated with a low mortality.

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Poststernotomy aspergillosis

Poststernotomy aspergillosis: successful treatment ‎with voriconazole, surgical debridement and ‎vacuum-assisted closure therapy

Rinaldo Focaccia Siciliano,I Daniel Reis Waisberg,II Marcos Naoyuki Samano,II Paulo Ferreira Leite,III Paulo Tuma Ju´ nior,IV Guilherme Cardinali Barreiro,IV Tania Mara Vareja˜ o StrabelliI

  • Hospital das Clı´nicas (HCFMUSP), da Faculdade de Medicina da Universidade de Sa˜ o Paulo, Infection Control Team, Heart Institute (InCor), Sa˜ o Paulo/SP, Brazil. II Hospital das Clı´nicas (HCFMUSP), da Faculdade de Medicina da Universidade de Sa˜ o Paulo, Division of Thoracic Surgery, Heart Institute (InCor), Sa˜ o Paulo, Brazil. III Hospital das Clı´nicas (HCFMUSP), da Faculdade de Medicina da Universidade de Sa˜ o Paulo, Chronic Coronary Diseases Unit, Heart Institute (InCor), Sa˜ o Paulo, Brazil. IV Hospital das Clı´nicas (HCFMUSP), da Faculdade de Medicina da Universidade de Sa˜ o Paulo, Division of Plastic Surgery, Sa˜ o Paulo, Brazil.


Tel.: 55 11 9891-6293


Aspergillus spp. are ubiquitous in the environment, includ-ing the air, soil and decomposing material (1). Human invasive aspergillosis arises from the inhalation and contig-uous spread of Aspergillus to adjacent sites (e.g., petrous bone, the sinuses, the palate). Occasionally, human invasive aspergillosis can be the result of the direct extension or hematogenous spread from pulmonary foci or of intravenous drug abuse (1). Invasive aspergillosis typically occurs in immunocompromised patients. Interestingly, some cases of surgical wound infection have been reported in immuno-competent individuals (1). The occurrence of post-operative aspergillosis can be associated with the dissemination of spores in the operating room through the ventilation system, which can lead to the contamination of exposed tissue, the surgical materials, the prosthesis or the wound dressing (1).

Deep bone wound infection is a severe complication of coronary artery bypass graft (CABG) surgery. Chronic osteomyelitis is unusual, reported in 1 to 4% of patients, and is most frequently caused by staphylococci (2,3). Aspergillus spp. are rare but recently recognized causes of nosocomial chronic sternal infections, including especially difficult-to-treat cases of osteomyelitis/costochondritis of the sternum (1).

The optimal treatment for invasive bone aspergillosis is a combination of surgical treatment and appropriate anti-fungal therapy. Currently, voriconazole is being advocated for the treatment of invasive aspergillosis (4,5). Herein, we report an unusual and very interesting case of chronic osteomyelitis and costochondritis caused by aspergillosis of the chest wall following cardiac surgery in an immuno-competent patient who was successfully treated with vacuum-assisted closure therapy following surgical debri-dement and voriconazole therapy.

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Successful application of vacuum-assisted closure therapy for ‎treatment of mastitis-associated chronic breast wounds

Received: 7 April 2010 / Accepted: 6 July 2010 / Published online: 21 July 2010

Springer-Verlag 2010


Introduction Although non-puerperal mastitis is rare and its cause is rather unclear, the number of patients diagnosed with this defect is increasing. In some cases, standard therapy fails and it progresses to a chronic disease. Vac-uum-assisted closure (VAC) therapy has shown good results in healing complex wounds. Patients and methods The goal of this study was to evaluate our experiences with VAC therapy and to answer the question whether or not should be accepted as an effective treatment in healing chronic wounds caused by non-puerperal mastitis. Retrospectively, we identified five patients with a non-puerperal mastitis chronic wound that was treated using VAC and report on their outcome. Results We reached both wound control and closure of the breast wounds in all patients. Conclusion According to our findings, the VAC therapy can be considered when managing challenging breast wounds, particularly when other therapeutic options have failed. The role of VAC therapy as a primary therapeutic option has not yet been evaluated.

Keywords Breast Mastitis Surgery Vacuum-assisted closure

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Sample of wounds

Intravenous wounds

Intravenous ulcers These types of ulcers are caused by standing veins in the standing position. Blood returns to the heart via veins and by the muscle of the leg muscles in the lower limbs contrary to gravity. Ineffective muscle pump The leg causes blood to remain in the veins and, as a result, increases pressure on the lower limbs. This pressure is transmitted to small veins and capillaries, causing incomplete blood circulation and poor blood supply to the tissues and scarring. Normal muscle pump consists of 5 components: 1- superficial veins2- perforator veins3- deep veins4- ankle muscles5- ankle joint There are three types of veins in the lower limbs; superficial veins through perforator veins to deep veins . The intravenous system has unilateral two-valve valves that open only to the deep veins and the heart. Deep veins have a greater number of these valves than the surface, and the perforator veins open to the deep veins. Blood flow within the veins is mainly (90%) caused by contraction and relaxation of the leg muscles. When the leg muscles contract, blood moves to the heart and when the muscles come out of the contraction, the veins expand and fill with blood.

Diabetic wound

Diabetes or diabetes mellitus is a common and debilitating human condition that can cause serious problems for the organs. One of the problems is chronic and refractory ulcers, which usually occur on the soles of these patients. This is also called diabetic foot disease.

The problems that arise for people with diabetes are due to two major causes of diabetes. These two problems are peripheral nerve disorders and decreased blood flow to the extremities.

نمونه زخم

Arterial wounds

Arterial ulcers are a manifestation of systemic atherosclerosis.

It usually affects about 12% of adults. The most common manifestation is intermittent lameness (inability to walk).

Atherosclerosis is the most common cause of peripheral artery blocking disease.

A stable plaque is well tolerated, but unstable plaque (which tears the coagulation system inactive) can endanger the patient’s body or life.


Advanced wound healing

Chronic wounds have a negative effect on the quality of life and productivity of the patient, with significant financial burdens for the health care system.

Lower extremity ulcers, especially those associated with diabetes, venous disease or arterial disease, comprise a significant proportion of chronic ulcers. Approximately 15 to 25 percent of people with diabetes develop ulcers in their lifetime, and about 12 percent of these patients require amputation. The treatment of these ulcers, which is complicated by diabetic polyneuropathy and the high prevalence of infection. Venous disease is the most common cause of chronic lower limb ulcers. Intravenous hypertension for various reasons can damage the walls of the veins and eventually lead to skin fractures. Arterial ulcers are less common and impaired circulation can adversely affect the wound healing process.