articles

Abstract

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.

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

Abstract

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.

Abstract

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.