Vacuum-assisted closure for the management of wounds: an accelerated systematic review

Pham C, Middleton P, Maddern G
Record ID 32004000204
English
Authors' objectives:

To assess whether the management of non-healing wounds using vacuum-assisted closure (VAC) therapy will result in improved efficacy and safety outcomes compared with conventional methods.

Authors' results and conclusions: Six RCTs of vacuum-assisted closure covering four indications - two on pressure sores and ulcers, one on diabetic foot ulcers, one on skin grafts and two on chronic and complex wounds, were reviewed. Also included in the review were four non-randomised comparative studies (three on sternal wounds and one on skin grafts) and seven case series studies (two each on skin grafts and chronic wounds and one each for pressure sores and ulcers, diabetic foot ulcers and sternal wounds). For management of pressure sores and ulcers, no difference could be detected between VAC and use of traditional gauze dressings or the Healthpoint (HP) system. Foot ulcers managed with VAC significantly decreased by 28.4% in surface area as opposed to those managed with saline-moistened gauze, which increased by 9.5% (p=0.004). VAC therapy appeared to be more effective than Opsite and bolster dressings in skin graft management. Patients managed with VAC had increased rate of reepithelialisation and fewer patients required repeat split thickness skin graft to the same site. VAC was more effective at treating various chronic and complex wounds than WM gauze, as there was a significantly greater reduction in wound volume, depth and treatment duration. Comparative studies on sternal wounds suggests that VAC may be more cost-effective than traditional dressings or closed drainage and irrigation, as VAC required a reduced number of dressing changes and number of flaps to close the wound, and a shorter treatment duration and length of hospital stay. This has the potential to reduce health care costs, for both hospital and patient, and enhance patient satisfaction and quality of life. A major complication for patients whose wounds failed to heal with VAC was amputation. This occurred in one patient with a pressure ulcer who developed sepsis and three patients with diabetic foot ulcers who required higher level amputation. Cases of periwound maceration and infection were also reported; however, it is unclear whether these complications were VAC-related. Some patients reported minor discomfort with the application of pressures greater than 100 mmHg.
Authors' recomendations: Although most studies were probably too small to detect significant differences, some results did show VAC to result in better healing than standard methods, with few serious complications. More rigorous studies with larger sample sizes assessing the use of VAC therapy on different wound types are required. With proper training to ensure appropriate and competent use, VAC is simple to use and appears to be a promising alternative for the management of various wound types.
Authors' methods: Systematic review
Details
Project Status: Completed
Year Published: 2003
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Australia
MeSH Terms
  • Foot Ulcer
  • Pressure Ulcer
  • Skin Transplantation
  • Vacuum
  • Wound Healing
  • Wounds and Injuries
Contact
Organisation Name: Australian Safety and Efficacy Register of New Interventional Procedures-Surgical
Contact Address: ASERNIP-S PO Box 553, Stepney SA 5069 Australia Tel: +61 8 8363 7513; Fax: +61 8 8362 2077;
Contact Name: college.asernip@surgeons.org
Contact Email: college.asernip@surgeons.org
Copyright: Australian Safety and Efficacy Register of New Interventional Procedures - Surgical
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