VAC Training Final

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com
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Synergy Life Solutions 9/29/2014
Our Partners
Negative Pressure
Wound Therapy
(NPWT)
In the management of
Wounds
by
Randika Perera

Basic wound management
debride
Surgical Chemical

Enzymatic
Basic wound management
dress
Healing
promoting
substance
Absorption
of
discharge

Dirty wound sketch

Clean wound sketch
Maitain a
moist and
clean
environment
A Dirty Wound
Debridement
A slowly healing wound
A traditional dressing
the way it works
A change of dressing
With the VAC on

History of NPWT. Therapy
Research started in 1989 by Dr. Louis Argenta
& Prof. Michael Morykwas of Wake Forest
University School of Medicine in North Carolina, USA
NPWT. originally designed to treat chronic wounds
NPWT. system released in Europe in 1994
Annals of Plastic Surgery June 1997- 175 cases
Removes interstitial fluid
allowing Tissue decompression
Reduces localized edema

Helps remove infectious
materials
Reduces bacterial colonization
Enhances dermal perfusion
Provides a closed, moist wound
healing environment
How
VACWOUND
Therapy Works
Encourages mechanical
stretching and approximation
of the wound edges
Applies negative pressure to
uniformly draw wound closed
(wound contraction)
Promotes wound healing via
stimulation of granulation
tissue
Promotes flap survival and
graft uptake
Enhances epithelial migration

Impact of
VACWOUND
Therapy on
wound bed
Vacuum Assisted Closure.
NPWT. is a noninvasive, active wound-closure
system that uses controlled, localized negative
pressure to promote healing in acute and chronic
wounds.

Granulation Tissue Formation
Ilizarov Method - use of tissue expanders to apply mechanical
stress to soft tissues to increase mitotic rates, (Ilizarov G A, 1989)
Thoma, 1911 - first postulation of the effects of mechanical stress to
encourage angiogenesis & tissue growth

Tension Stress Effect
Morykwas hypothesis: mechanical
stress (contraction of wound) helps
cause granulation tissue formation
(tissue growth)
Tissue stress effect similar to using
Ilizarov technique and soft-tissue
expanders to increase mitotic rates
Intermittent application results in
repetive release of second messengers,
further enhancing gran tissue
formation
The tension-stress effect on the genesis and growth of tissues. Part 1 Ilizarov GA Clin
Orthop Rel Res 1989;238:249-281
Reverse Tissue Expansion as dressing collapses in
wound cavity, it exerts a centripetal force on wound
edges
Swan Marc, Banwell Paul, Advanced Management of the Open Abdomen: Oxford Wound Healing Society, 2003
Increased Perfusion

Peak blood flow recorded at 125 mmHg
Study helped establish original pressure protocol with Foam Dressing
(400-600 micron pore-size)
Hypothesized that reduction in oedema decompresses small
blood vessels and increases flow
Frank Ischaemia and Wound Hypoxia
Morykwas Michael J, Argenta Louis C, Shelton-Brown Erica I, McGuirt Wyman: Vacuum-
Assisted Closure: A New Method for Wound Control and Treatment: Animal Studies and
Basic Foundation. Annals of Plastic Surgery, 1997; 38 (6)
Positive effect on
perfusion with 125
mmHg
Effects of Varying Levels of Pressure
Wounds treated at 125 mmHg exhibited a
significant increase (p<0.0001) compared with
treatments at 25 mmHg or 500 mmHg
Wound treated with 125 mmHg with a leak in
drape demonstrated a 197% increase in size
due to the need for surgical debridement of
necrotic tissue
The wound walls treated with 500 mmHg had
also thickened, resulting in wounds deeper
than the original depth
0
50
100
150
200
250
0 2 4 6 8
Days
% Original
Size
25 mm 125 mm 125 mm with 2mm hole 500 mm
Morykwas Michael J, Faler Byron J, Pearce Daniel J, Argenta Louis C: Effects of Varying
Levels of Sub-atmospheric Pressure on the Rate of Granulation Tissue Formation in
Experimental Wounds in Swine. Annals of Plastic Surgery, 2001; 47(5)
Reduction of Bacteria
All pigs (control and NPWT) were infected with 10
8
organisms /g tissue
VACWOUNDs exhibited significant decrease in number of micro-organisms
(<10
5
) on day 4-5, vs. day 11 for control group (bacteria colonisation reduced
1000X on days 4-5)

Argenta Louis C, Morykwas Michael J: Vacuum-Assisted Closure: A New Method for
Wound Control and Treatment: Clinical Experience
Annals of Plastic Surgery, 1997; 38 (6)
VACWOUND Therapy increase in
perfusion and oxygenation likely
enhances resistance to infection
Bacterial Clearance
0
3
6
9
12
Day 0 Day 1 Day 2 Day 3 Day 4 Day 5 Day 7
Time
log organisms
Vacuum Control Clinical Infection
At 125 mmHg, VACWOUND
Therapy significantly increased
granulation tissue formation
over wet-to-moist gauze
63.3% with continuous pressure
103.4% with intermittent pressure
0
20
40
60
80
100
120
Continuous Intermittent
Fig 2. Percent increase (mean + standard deviation) in the
rate of granulation tissue formation of acute wounds in
pigs compared to conventional wet-to-moist saline gauze
dressing changes (control).
Morykwas Michael J, Argenta Louis C, Shelton-Brown Erica I, McGuirt Wyman: Vacuum-
Assisted Closure: A New Method for Wound Control and Treatment: Animal Studies and
Basic Foundation. Annals of Plastic Surgery, 1997; 38 (6)
Reduction of Inhibitory Factors
Reduction of oedema has positive effect
in wound healing
Reduction of inhibitory factors contained
in interstitial fluid (chemical)
Decompression of small blood vessels,
which restores flow (mechanical)
Inhibition of Cell Proliferation by Chronic Wound Fluid
Brian Bucalo MD, William H Eaglestein, MD, Vincent Falanga, MD 1993 Wound
Repair and Regeneration
VACWOUND Therapy is indicated for
Acute Wounds(caused by trauma or surgery)
Sub-acute Wounds
Flaps & Grafts
Full-thickness surgical wounds
Chronic wounds -Venous stasis ulcers
Dehisced wounds
Acute Surgical Wounds
Pressure Ulcers
Ortho Trauma Wounds
Diabetic Wounds
Open Abdominal Wounds
Partial Thickness Burns

INDICATED for
TRAUMA WOUNDS
an application of 13 days
application of 9 days
Follow up after 20 days
Ideal wounds for Negative Pressure Wound Therapy
INDICATED for
DIABETIC FOOT
ULCERS
Result in 3 days
VENUS/ARTERIAL
LEG ULCERS

Acute Surgical Wounds
Pressure Ulcers

Diabetic Wounds
Open Abdominal Wounds
Skin Grafts
Partial Thickness
Burns

Pump
Dressing Installation
M.A.P.C.Microprocessor Assisted
Pressure Control
ubing

Continuous feedback system that constantly
monitors the negative pressure at the wound site,
compares it with the target pressure, and adjusts
accordingly, so that the wound site pressure is equal
to the target pressure.

Advantages
Provides more effective therapy because target sub atmospheric pressure
is monitored and maintained at Maximizes accuracy and effectiveness of
NPWT.
Therapy

Ensures controlled, consistent and safe NPWT.
the wound site, even

during patient movement
Enables the User to adjust the rate of negative pressure once the foam is
compressed in the wound to meet individual patients needs and increase
patient comfort
MAPC.

System alerts the User of tubing blockages and pressure leakages
to maximize patient safety

Aggressively clean wound
Debride necrotic tissue or eschar if possible
Achieve hemostasis
Shave hair around border if needed
Irrigate wound with normal saline
Dry and prep skin as appropriate
Cut foam to size of wound
Gently lay foam in wound, including tunnels,
undermining, and all surfaces

Materials needed:
Scissors (sterile or clean)
Gloves (sterile or clean)
Dressing kit
Canister
NPWT. Unit
Optional:
Skin prep Tincture Benzoin
Non-adherent dressing,
Aggressive cleaning of the wound at each dressing change is imperative to
decrease bacterial load and minimize odor
Cut the foam to fit the size and shape of the wound, including tunnels and undermined areas
Gently place the foam into the wound cavity, covering the entire wound base and
sides, tunneling and undermining
Cut the drape large enough to cover the foam and 3-5 cm of surrounding healthy tissue with drape.
Apply the drape beginning on one side of the foam, toward the tubing. Do not stretch the
drape and do not compress the foam into the wound with drape. This helps minimize
tension or shearing forces on periwound tissue.
Important: Foam should not overlap on to intact skin.
Applying the suction tubing
Cut hole in drape about 1.5 cm and apply tubing
Applying the suction tubing
Connect to Canister
Connect dressing tubing to canister tubing, making sure clamps are open
Y-Connecting
A Y-connector is available to connect 2 or more wounds to one NPWT. pump
NPWT. Canister
Canister has graduated marks to measure exudate. Change at least once per week or
when full.
Canister with Isolyser
Canister comes with Isolyser gel that gels fluid on contact and helps eliminate odor
Dressing in Place with Therapy OFF
Dressing with Therapy
ON
Therapy is turned on and foam is pulled down into wound
Adjusting NPWT. Pressure
Standard is 125 mmHg
May turn down (minimum 75 mmHg) when:
Unrelieved pain
Bruising in wound bed
Elderly and nutritionally compromised patient
Excessive bleeding
Compromised circulation (PVD)
Excessive granulation tissue growth
Adjusting NPWT. Pressure
May turn pressure up when:
Excessive drainage
Large wound volume
Using NPWT. Soft-Foam (White Form)
Difficulties maintaining a seal

Continuous vs. Intermittent

Continuous therapy:
Always for at least first 48 hours
Maintain for length of treatment when:
Significant discomfort in intermittent mode
High amounts of exudate
Wound requires constant contraction (sternal
wounds, tunnels)
Intermittent therapy
Use to stimulate granulation tissue faster

Low pressure (leak) alarm (delayed)-Excessive Leakage
Therapy NOT ON alarm (delayed 15 minutes)
Canister full alarm
Canister out alarm
Consumable Block

Alarm delay button will temporarily delay audible alarm
If cause of alarm is not resolved within 5 minutes, unit
automatically shuts off
NPWT. can run off an internal battery. Clips to the end of bed or IV pole.
NPWT. can be used on infected wounds
Change dressings more often until clinical
signs of infection go away (usually 3-5 days)
Be sure to keep therapy ON
Be sure to clean wound aggressively at
dressing change

Decrease in overall wound volume should be noted from
week to week
Wound should become beefy red initially
Wound may look larger at beginning because of removal of
edema
May be oozing of blood from disruption of capillary buds as
granulation tissue develops
Wound should become redder as granulation tissue increases

Color of wound may then become paler as amount
of collagen in wound increases
Likely gradual decrease in exudate levels
New epithelial growth should be evident at viable
wound edges


Practical Tips:
Wound Wont Seal
Leaks generally make whistling sounds; listen
closely for them
Check around connector and tubing first
Gently pat around perimeter of wound to seal
off air leaks
May need to seal over drain holes
If you cant hear it, sometimes listening with
stethoscope can pinpoint leak
Practical Tips:
When goal of therapy has been met
Most of the time NPWT. used to prepare wound
for surgery
Sometimes NPWT. will take wound to full closure
When wound shows no progress for 1-2 weeks
Abdomen
Exposed metal

Orthopedic Trauma
Post Flap
Result of
2 VAC
dressing
application
Case of
Trauma
Amputation
with complication
of diabetes Synergy Life Solutions 9/29/2014
Crushed Injury
Amputation
VACWOUND
Therapy applied
for 4 days
Case of ROAD ACCIDENT
HBsAg Positive
Result of VAC application for 12 days
Initiation of VAC
Post Graft
Road Accident case : with no
vessels for primary closure
(results of 13days VAC application)
A Result of 4-5
days VAC
application
Stump
Amputation
Stitch line Infection
Wound ready for secondary closure
after 4 days VAC application
Result of 3 days VAC application
Helps to stimulate granulation tissue
formation
High drainage capacity, therefore
particularly suitable for heavy
exudating and infectious wounds

VACWOUND Black PU Foam
is made of open cell, polyurethane(PU) material
Physical characteristics prevent tissue in-growth
High tensile strength makes it easier to handle
when placing and removing from tunnels
and smaller spaces
Non-adherent
VACWOUND VersaFoam
is made of a micro-porous, polyvinyl alcohol(PVA) material
How VAC helps in Flaps & Graft
Fixation of skin grafts (mesh-grafts) until
the graft has taken (4-6 days). In these
special cases, VACWOUND Therapy is
used for the secure fixation of a split skin
graft to the wound. The soft foam helps
gently press the graft onto the wound
bed and thus ensures full contact
between the graft and the underlying
wound bed, irrespective of the wound
contours and the formation of pockets
CONTRAINDICATIONS
Necrotic tissue with eschar present
Wound should be debrided to remove
majority of necrotic tissue and eschar
Untreated Osteomyelitis
Exposed blood vessels or organs
Ensure all vessels or underlying organs are
protected with overlying fascia, tissue or other
protective barrier
PRECAUTIONS
Active bleeding

Difficult wound haemostasis

Patients who are on anticoagulants
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the wound site, even

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