How To Use VAC Therapy On Chronic Wounds

By Brian Short, DPM, Matthew Claxton, DPM, and David G. Armstrong, DPM

Chronic wounds such as diabetic foot ulcers, venous stasis ulcers and decubitis ulcers are leading causes of morbidity and mortality in elderly patients and significantly contribute to health care costs.1-4 Wounds of these types often lead to complications such as infection and amputation.5-7 The ADA currently reports diabetes is prevalent in at least 17 million Americans, many of whom do not know they have the disease. Of these, approximately 15 percent will experience a foot ulcer or other complication requiring hospitalization during the course of the disease.8, 9
Similarly, venous wounds affect a large population. A recent investigation in Great Britain found the annual prevalence of venous stasis ulcerations to be 1.69 percent in patients ages 65 to 95.4 Regardless of the underlying cause of the ulceration, conservative estimates report that more than 2 million people in the United States are currently being treated for chronic, non-healing wounds.
For many years, chronic wounds have been the subject of intense research in an effort to find methods to increase healing rates and decrease complications. Manipulation of the macroscopic and microscopic environments of wounds has been the key to success in healing both the acute and chronic wound. Wound treatments have ranged from the simple but effective wet-to-dry dressing to topical and systemic pharmacotherapy and biologic agents, including growth factors and skin substitutes or grafts.10
Then there is VAC Therapy (KCI). Well, understanding the usefulness of VAC therapy requires knowledge of the basic science behind a chronic wound. Chronic wounds typically represent a breakdown in the transition between the substrate and proliferative stages of wound healing.12 All stages of wound healing can actually be present in a single chronic wound. Many factors, such as vascular disease, diabetes, pressure, infection, environmental stress, age, nutrition, immune status and pharmacologic agents (both systemic and topical) have been reported to affect the wound environment adversely.13, 14

Using the subatmospheric pressure of VAC therapy can alter the wound environment by reducing bacterial load and chronic, often inflammatory, interstitial wound exudate; potentially increasing vascularity and cytokine expression; and physically contracting wound margins.15 All of these characteristics, particularly the removal of deleterious proteases, may help to convert a tattered wound bed into a red carpet of healthy granulation tissue so it may progress through the subsequent phases of wound healing.16


I tracked incorrectly to a chronic wound, there was maceration before and increased when dressing changed. Should you stop using the VAC?

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