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Library: Article
Title: Vacuum-assisted closure is here!!
Date: 7/1/10
Detail:
Many dogs and cats present with either wounds that are large, contaminated or chronic, that require intensive management to ensure successful healing. Traditional first-line wound management tools are analgesia, sedation or anesthesia, debridement, lavage and wet-to-dry bandages. Such bandages may require frequent (multiple times per day) dressing changes, often requiring heavy sedation or anesthesia. In both human and veterinary medicine, many clinicians are choosing wound management options that minimize cost, morbidity and risks associated with frequent sedation or anesthesia.
Vacuum-assisted closure (VAC) therapy is a non-invasive, active, wound management system that exposes a wound bed to local sub-atmospheric pressure contained within a closed environment. By creating this closed, negative pressure environment, VAC therapy removes fluid from the extra vascular space, improves circulation, enhances the proliferation of granulation tissue, increases bacterial clearance and hastens wound closure.
Basic wound care principles must be adhered to prior to the initiation of VAC
therapy. Proper debridement of devitalized tissues is essential to eliminate
any potential nidus for bacterial growth and to allow for successful wound
closure following VAC therapy. Incomplete wound debridement prior to the application
of VAC therapy may result in the proliferation of granulation tissue over necrotic
tissues, delaying wound healing and promoting abscess formation. Figure 1 (devitalized
wound). The frequency of VAC bandage changes (Figure 2 - VAC in place) depends
on the characteristics of the individual wound. VAC bandages are typically
changed every 48-72 hours, although when initially managing traumatic or highly
contaminated wounds the bandage may need to be changed every 24 hours to allow
for adequate debridement. (Figure 3 - wound after 72 hours) If VAC bandages
are left in place for more than 4 to 5 days, granulation tissue may grow into
the pores of the open cell foam requiring surgical removal of the foam bandage.
(Figure 4 - after secondary wound closure)
Dr. Alastair Coomer acoomer@vscdsurgerycenters.com has
utilized VAC in many clinical scenarios, including snake-bites, shearing and
degloving injuries, bite wounds, septic peritonitis, skin grafting and many others.
Veterinary Surgical Centers now has a VAC therapy unit and welcomes your consultation
or referral for wounds or other soft tissue pathologies.
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Figure 1. devitalized wound |
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Figure 2.
VAC in place |
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Figure 3.
Wound after 72 hours |
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Figure 4.
Wound after secondary closure |
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