Combining VAC Therapy With Advanced Modalities: Can It Expedite Healing?
Seroma formation is one of the most common reasons leading to the “failure” of bioengineered skin replacements. The application of NPWT at a lower setting may serve as a mechanical, highly effective bolster dressing to mitigate shear forces and hematoma/seroma formation, and facilitate “uptake.” This would be similar to the technique one would employ to potentiate the uptake of autogenous skin grafts.33-35
Although there are currently no clinical trials that validate the combined use of NPWT with bioengineered skin replacements, there have been anecdotal reports of combining NPWT with other bioengineered tissue equivalents such as regenerative tissue matrix (Graftjacket, Wright Medical Technology), bilayered cellular matrix (Orcel, Ortec), and bilayer matrix wound dressing (Integra, Integra LifeSciences).
Jeschke et. al., examined the healing of deep, complex wounds with the combinational use of bilayer matrix wound dressing and NPWT.36 This combination expedited wound healing and resulted in wounds that were ready for split thickness skin grafts in a mean of 7.25 days. They found that NPWT improved both the take rate and time to vascularization of a bilayer matrix wound dressing when compared to previously published results using the bilayer matrix wound dressing alone.
Over the past decade, there have been numerous advances in wound care. Despite these advances, it is important to realize that the causes of ulceration are often multifactorial and there is no one product that will heal all wounds. Caring for a patient with chronic ulceration is complex and necessitates multidisciplinary collaboration to achieve the goal of providing comprehensive wound care. The combined use of NPWT with other advanced wound healing modalities may be a useful synergy in the armamentarium of wound healing. We are hopeful that future works in the literature will guide the clinician toward what may ultimately be a common sense conclusion.
Dr. Wu is an Assistant Professor in the Department of Surgery at the William A. Scholl College of Podiatric Medicine at the Rosalind Franklin University School of Medicine in Chicago. She is a Fellow at the Center for Lower Extremity Ambulatory Research (CLEAR) in Chicago.
Yoon is a second-year student at the William A. Scholl College of Podiatric Medicine at the Rosalind Franklin University School of Medicine in Chicago.
Dr. Armstrong is a Professor of Surgery, Chair of Research and Assistant Dean at the William M. Scholl College of Podiatric Medicine at the Rosalind Franklin University of Medicine in Chicago. He is also a member of the National Board of Directors of the American Diabetes Association.
Dr. Steinberg (pictured) is an Assistant Professor in the Department of Surgery at the Georgetown University School of Medicine in Washington, D.C. He is a Fellow of the American College of Foot and Ankle Surgeons.