Senthil Kumaran, B (2014) Role of vacuum assisted closure in complex wounds. Masters thesis, Plastic Surgery.
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Abstract
INTRODUCTION: Vacuum-assisted closure (VAC) is new in the armamentarium of managing wounds acute and chronic. Vacuum assisted closure also called negative pressure wound therapy is a procedure in which vacuum is used to enhance wound healing vacuum-assisted wound closure refers to wound dressing that uses pressure below normal continuously or intermittently to the surface of a wound. The negative pressure is maintained by an apparatus, this promotes healing in various kinds of wounds. It also helps in wound debridement .Wounds heal best when the negative pressure is 125 mmHg. Negative pressure removes fluid, decreases edema and increases blood flow. Thus decreasing bacterial counts. The technique is less expensive than conventional management of complex wounds. The technique is relatively simple. sterile, porous foam dressing is directly placed on the wound. The wound is then closed with a sterile adhesive sheet in order to create a closed area. A tube is connected to a vacuum pump,fluid is sucked through the foam into a canister which is discarded. Negative pressure of 50-125 mm/Hg, results in the lowering of interstitial pressure, and fluid and debris from the wound is sucked into a collection chamber. In the begining, the vacuum is continuous . As the drainage decreases, the vacuum is applied intermittently. The vacuum dressing is usually changed at approximately two day interval. Wound progress is recorded using parameters in the wound scoring system. The objectivity of assessments used to mark the wound score make this scoring system deal for evaluating treatment and outcome of wounds. And effectiveness of this treatment is established and proven by this objective scoring system. OBJECTIVES OF THE STUDY: 1. To study the outcome of vacuum assisted closure of wounds. 2. To evaluate the positive impact of vacuum assisted closure on wound healing in enhancing granulation tissue formation. MATERIALS AND METHODS: Source of Data: • Inpatients of Rajiv Gandhi Govt General Hospital. • Method of collection of data. • A total of 50 cases clinically presenting as ulcer between January 2011 and July 2012 were included in the study. Inclusion Criteria: Patients presenting with Wound. Exclusion Criteria: • Patient with Bleeding disorders. • Untreated osteomyelitis. • Bleeding wounds. • Patients diagnosed as malignancies. • Clinical examination of each case was done systematically as per the proforma drafted for the study. Procedure: Dressings from the wound is removed . A swab for culture is taken. Wound irrigated with normal saline. Surgical debridement is done and adequate haemostasis achieved. RESULTS: This study was done on fifty patients in the Department of Plastic Surgery, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai. Most of the patients presenting with wounds were in the 5th decade of life 18 (36%), followed by the 6th decade 17 (34%). Wounds were more common in males 38 cases (76%) than in females 12 cases (24%) Male to female ratio 3.167: 1. Wounds were more common in males 38 cases (76%) than in females 12 cases (24%) Male to female ratio 3.167: 1. Based on the duration of wounds, cases were grouped into 3 categories: <10 days, 10-30 days and >30 days. Most cases fall in the group 10-30 days 30(60%), 19 cases(38%) in the group <10 days and 1 case (2%) in the group > 30 days. Wounds were most commonly located in the foot 20(40%) followed by the leg 16(32%), forearm 5(10%) and ankle and sole 4(8%) each. One patient had wound in the abdomen. Significant difference in wound healing depending on the location of the wound. P value-0.024. 27 (54%) of cases were smokers, 23 (46%) were non- smokers. Based on etiology of wounds, which were determined by history and clinical examination, wounds were divided into Traumatic, Diabetic and Vascular. A major portion 25(50%) of cases fell into traumatic group and 18(36%) into diabetic and 7 (14%) into vascular group. Diabetic and non-diabetic wounds constituted 18(36%) and 32(64%) cases respectively. Wounds of area < 20 sq cm constitute maximum number of cases - 44(88%). Wound area show an impact on wound healing. Smaller the wound area, wound healing was better compared to larger wound area. P value- 0.001. Most common organism cultured from the wounds was Staphylococcus aureus 21 (42%). Following VAC therapy for 3 to 7 days most of the wounds showed progress in wound healing. CONCLUSION: VAC therapy is a recent modality of treatment of wounds. Its introduction has changed the course of management of wounds. Based on the data from the present study and other studies available, VAC results in better wound healing, with very few complications, and promises to be a good modality in the management of various wounds. The usage of VAC is simple, but needs minimal training for competent use. Awareness about VAC and training on application of VAC dressings will make it more popular.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | vacuum assisted closure ; complex wounds. |
| Subjects: | MEDICAL > Plastic and Reconstructive Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 01:48 |
| Last Modified: | 12 Oct 2017 01:48 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3504 |
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