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VAC Therapy: A
Valuable Adjunct to Wound Care Armamentarium. Ann Pak Inst
Med Sci 2012;8(2):
EDITORIAL
Muhammad Saaiq
Assistant Professor,
Burn Care Centre/ Plastic Surgery, PIMS, Islamabad.
E-mail muhammadsaaiq5@gmail.com
Medicine is an ever evolving science. The present day medicine is termed as evidence based
medicine wherein practice and policies are guided by sound clinical and experimental evidence
supporting the benefits and safety of a given therapeutic modality. Over the last decade,
Vacuum Assisted Closure therapy (VAC therapy) has emerged as a novel adjunct to the
How does the VAC therapy work? Since the technique is relatively new, its exact mechanism
of action still continues to be researched. A variety of interrelated factors have been identified to
account for its favorable effects on wound healing. These factors can be summarized into three
subgroups i.e. removing, reducing and Improving. Firstly the edematous tissue planes
surrounding the wound are characterized by localized collection of interstitial fluid that contains
inhibitory factors that suppress mitosis, fibroblasts activity, collagen production, and cell growth.
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The VAC therapy actively withdraws this fluid and its constituent inhibitory factors. Secondly
the VAC therapy reduces the bacterial counts of the wound to a level far lower than what can
cause infection. Thirdly VAC therapy improves the entire healing process through its direct
and indirect effects. With removal of local edema, the microcirculation and lymphatic/ venous
drainage is reestablished. The delivery of oxygen and nutrients to the wound is optimized. The
micromechanical forces of low pressure suction exerts an Ilizarovian effect at cellular level,
Angiogenesis. The moist environment provided by VAC technique promotes granulation tissue
formation and healing. 4-6 The wound if small is thus encouraged to close spontaneously. Larger
and complex wounds are rendered suitable for definitive reconstruction with skin graft or flap.
How can the VAC therapy be applied to a wound? Not surprisingly with growing
understanding of the mechanism involved, one can easily construct a VAC dressing at bed side
and convert an open wound into a close controlled one. Before its application to the wound,
once must make sure that wound is first adequately debrided with excision of all devitalized
tissues. Two sheets of synthetic foam are then tailored the size and shape of the wound and the
wound is covered with them with a Redivac suction drain placed between the two sheets. A
transparent sealing plastic membrane sheet such as Opsite or plastic food wrap is then applied
to the foam layers, making the system water tight and air tight. The suction drain is connected to
Suction machine or wall vacuum suction maintained at 50-120 mmHg. It is maintained for five
days, at which point the VAC dressing is removed. A fresh VAC dressing may be applied for
another five days and the wound re-evaluated for further definitive management. 1
What kind of wounds are suitable for VAC therapy? In fact the VAC therapy finds almost
universal applicability across a range of wounds, with only few contraindications such as
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malignancy, bleeding diathesis and exposed major blood vessels. When employed, VAC therapy
helps to temporize wounds, giving time for stabilization of the patient until complex
reconstructive procedures can be instituted on a prepared wound bed. It is effective both in the
preparatory phase of wound prior to any reconstruction and as postoperative dressings for
Owing to its low cost, VAC therapy provides an economical alternative to the other available
costly local wound management measures. Such economic implications of wound management
are particularly important in the context of our limited health budgets. It also reduces the need
for daily change of dressing thus comforting the patients on one hand and reducing the work
load of the staff responsible for wound dressings on the other hand. With expeditious wound
Given the growing body of quality evidence, VAC therapy should be adequately employed
particularly in the problem wounds and in the problem patients such as those with diabetes
mellitus and peripheral vascular disease. Nonetheless once must not forget that it is an adjunct to
other established wound care measures such as thorough debridement and not a substitute for
them.
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