Wound care is an ever evolving aspect of nursing and one of the most critical in regards to patient well-being. A patient who has difficulty healing, those with diabetes, immune system deficits or poor nutritional status pose even greater challenges. While the methods and products for wound care are seemingly endless, an extremely valuable tool in wound care is the use of negative pressure wound therapy (NPWT) also known the wound vac.
Wound vac therapy has evolved over the last 10-15 years. The devices are small enough to allow in home therapy as well as being portable to improve quality of life for those receiving the therapy. This evolution also means a greater variety of wounds are being treated with negative pressure. Soft tissue wounds are the most common applications for wound vacs but there are cases of the wound vacs being placed over fistulas with good results. Some reports describe the foam being placed over vessels, organs and nerves. Ideally these locations should have muscle or soft tissue between the dressing and these structures. However, if this placement is necessary then some advocate for it with the use of Silicone or Vaseline mesh to reduce complications. Other evidence indicates that the use over these types of tissues are not recommended at all and should be avoided. There are also cases of the vac being used in acute soft tissue injuries such as trauma orthopedic injuries with the device being placed over bone or tendon causing granulation tissue to form which allows for a skin graft placement at a later date. Vascular tissue has been noted to develop over artificial joint hardware, synthetic vascular graft, and synthetic mesh. [1, 2]
In one comparison of wound vac therapy to traditional wet-to-dry dressing changes there was little difference in ultimate wound reduction but a marked difference in closure rate. The vacuum assisted closure (VAC) reduced the size of the wound by 47% while the wet-to-dry (CWD) reduced it by 41%. Vac drainage reduction was 49% while CWD 39%. The cost of CWD supplies is an estimated 1/7 of the VAC cost. However, in wound closure time the VAC increased that rate by nearly 4 times that of the CWD which significantly reduced morbidity. [3]
While wound vac therapy has many benefits it does not come without significant risks. Instances of hemorrhaging as well as infection have been reported. The bleeding cases were noted to be caused by the vac being placed over grafted vessels or the wound being infected. The use of anti-coagulants in wound vac patients also contributed to the known cases of hemorrhage. Wound infections have been linked to inadequate removal of the foam packing material during dressing changes or the wound bed being damaged by the removal of the foam. This damage also contributed to instance of severe bleeding. Hospitalization, surgery and blood transfusions have all been results of these complications, and in a few instances death as occurred. [2]
Knowing the benefits and risks of all types of wound care is important to our patients. Knowing when to use a wound vac, how to apply and remove the dressings appropriately, situations in which to avoid its use and the possible complications involved can make a tremendous difference in the outcomes of wound healing. The patients being cared for deserve the best possible treatment and the appropriate use of a wound vac may be at the top of the list in providing that care.
[1] Advances in Wound Healing: A Review of Current Wound Healing Products. Patrick S. Murphy and Gregory R. D. Evans. https://www.hindawi.com/journals/psi/2012/190436/ (retrieved 11/14/2012)
[2] FDA Safety Communication: UPDATE on Serious Complications Associated with Negative Pressure Wound Therapy Systems. https://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm244211.htm#summary. (Retrieved 11/14/2012)
[3] Use of vacuum-assisted wound closure to manage limb wounds in patients suffering from acute necrotizing fasciitis. Huang WS, Hsieh SC, Hsieh CS, Schoung JY, Huang T. https://www.ncbi.nlm.nih.gov/pubmed/16877210 (retrieved 11/14/2012)