Indian J Surg (July–August 2013) 75(4):302–305
DOI 10.1007/s12262-012-0490-z
ORIGINAL ARTICLE
Results of Vacuum Assisted Wound Closure Application
Tolga Atay & Halil Burc & Yakup Barbaros Baykal &
Vecihi Kirdemir
Received: 5 September 2011 / Accepted: 4 April 2012 / Published online: 19 April 2012
# Association of Surgeons of India 2012
Abstract In recent past, various methods have been used vacuum-assisted wound closure can be regarded as satisfac-
for wound treatment purpose. In this study, we aimed to tory when cases are selected properly. This system has three
compare our results established from the vacuum-assisted different effect mechanisms. Firstly, it increases local blood
wound closure method, which has gained popularity day by flow on the wound bed. Secondly, cell proliferation is trig-
day, with the literature. A total of 48 patients, who received gered following the mechanic stress. Thirdly, vacuum
vacuum-assisted wound closure treatment in our clinic be- removes the proteases from the environment which
tween 2007and 2010, were included in this study. Etiolog- obstructs healing. Therefore, it is intended to prepare alive
ical distribution of the patients was as follows: 32 traumatic, wound bed which is required for subsequent soft tissue
6 pressure sore, 9 diabetic, and 1 iliac disarticulation. All reconstructions.
cases were evaluated in terms of age, gender, etiology,
period of treatment, and size of the wound. In the patients Keywords Wound healing . Negative-pressure wound
studied, 42 were men (87.5 %) and 6 were women (12.5 %). treatment
Mean age of the patients was 39.6 years (11–61 years). All
of our traumatic patients suffered from open fracture. After
the vacuum-assisted wound closure application, wound size Introduction
reduced by 28.8 %, while the mean area of the surface of the
wound was 94.7 cm2 (13.7–216.3 cm2) on average. After Acute and chronic wounds affect 1 % of the general popu-
the wounds became ready for surgery, 15 of them were lation [1]. Regardless of the etiology, treatment is generally
treated with split-thickness grafting, 9 of them were treated more complicated when the patient also suffers from infec-
with secondary suture, 18 of them were treated with full- tion, diabetes, or other diseases. Such wounds may result in
thickness grafting, and 6 of them were treated with flap. various conditions including hospitalization, amputation,
Average period of the application of vacuum-assisted sepsis, and even death. Today, wound treatment may take
wound closure was 11.6 days (7–15 days). Results of very long time, and it may cause painful and repetitive
hospitalization and surgical procedures.
Several treatment methods have been utilized for improv-
T. Atay (*) : H. Burc : Y. B. Baykal : V. Kirdemir ing the healing process of the wound until today, including
Süleyman Demirel University School of Medicine,
various medical dressings, topical applications, surgical de-
Department of Orthopaedics and Traumatology/Isparta,
32040 Çünür Isparta, Turkey bridement, and antiseptic medicines [2–4]. Great efforts
e-mail: ataytolga@[Link] were achieved to develop new products to improve wound
H. Burc healing. The vacuum-assisted wound closure method, which
e-mail: halilburc@[Link] was developed in the late 1980s, is the most recent method
Y. B. Baykal in this regard [5].
e-mail: barbarosbaykal@[Link] The vacuum-assisted wound closure system consists of a
V. Kirdemir sterilized open-cell foam covering, which is covered with
e-mail: vkirdemir@[Link] transparent, adhesive cover and its attached pump. The
Indian J Surg (July–August 2013) 75(4):302–305 303
Fig. 1 After the application of
vacuum assisted wound closure
treatment, situation of the
wound bed of the pressure sore
caused by orthesis used by the
patient who were previously
treated with below-knee ampu-
tation because of diabetic foot
pump applies intermittent or continuous negative pressure and polyvinyl alcohol were used to fill the wound during
on the foam cover by means of a nonbended discharge tube. application. Adhesive and semi-permeable closure films
Vacuum pressure is usually kept between 50 and 125 mm were used to cover the wound. Negative pressure of 100–
Hg, and it can be applied intermittently or continuously [6]. 125 mm Hg was applied on the wound (continuously for the
The purpose of vacuum-assisted wound closure treatment first 2 days and intermittently for the subsequent days).
is to remove the edema fluid (seroma or hematoma) from the Medical dressing was changed every 48 h. Size of the
wound area by applying negative pressure on the wound bed, wound was measured during medical dressing and wound
to improve local blood flow, to stimulate cellular proliferation/ surface was cleaned. Longest horizontal and vertical lengths
granulation, and to control bacterial colonization [7]. were multiplied to measure the approximate wound size. All
Vacuum-assisted wound closure treatment is a noninva- wound size values measured before and after the application
sive method which more popularly day by day can remain. were recorded. Vacuum-assisted wound closure treatment
The aim of the study was to share our experience and results was finalized when the wound area became suitable for
obtained from the cases treated with the vacuum-assisted surgical operation following the formation of sufficient
wound closure method. granulation tissue on wound surface. All these cases which
we have investigated retrospectively were evaluated with
regard to the factors of age, gender, etiology, treatment
Patients and Method period, and wound size.
We retrospectively examined the data of 48 patients, who
were treated with vacuum-assisted wound closure between Findings
2007 and 2010 at our department of Orthopedics and Trau-
matology of the Suleyman Demirel University School of Of the 48 participants, 42 were men (87.5 %) and 6 were
Medicine. The inclusion criteria were based on the existence women (12.5 %). Average age was 39.6 years (11–58 years),
of primarily unclosed wounds and surgically untreated and average period of the application of vacuum-assisted
patients. wound closure was 11.6 days (7–15 days). Etiological dis-
We used the vacuum-assisted wound closure system (Ki- tribution of the patients was as follows: 32 traumatic
netic Concept Inc. USA) in this study. Polyurethane sponges (66.6 %), 6 pressure sore (12.5 %), 9 diabetic (18.75 %),
Fig. 2 Before and after vacuum
assisted wound closure
treatment on the wound of the
patient, which wound could not
be primarily closed and who
were treated with faciotomy
because of compartment
syndrome
304 Indian J Surg (July–August 2013) 75(4):302–305
and 1 iliac disarticulation (2.08 %). One patient with iliac Even though effective mechanism of the vacuum-assisted
disarticulation was operated because of osteosarcoma on the wound closure system is not definitely known, there are
left femur. Vacuum-assisted wound closure treatment was some theories. The first assumption is that increase in local
applied to primarily unclosed limb stump that exhibited blood flow in the wound bed as a result of negative pressure
necrosis after the surgery. Vacuum-assisted wound closure results in removal of the excessive fluid, which in turn
treatment was finalized when sufficient granulation tissue contributes to the improvement of the local capillary circu-
occurred on the wound surface. After the treatment, wound lation and oxygenization. According to the second theory, it
surface was covered with split-thickness grafting. is estimated that angiogenesis and tissue growth are stimu-
All of our traumatic patients have had open fracture. lated and these processes give rise to cell proliferation as a
Following vacuum-assisted wound closure treatment, it is result of mechanical tissue stress. The final theory is that
observed that wound surfaces have significantly nar- vacuum effect removes the protease molecules which con-
rowed, development of granulation tissues have im- stitute an important negative factor against wound healing
proved, and wound secretion has decreased. While the and bacterial load decreases following this event [12–15].
mean wound surface measurement value was 94.7 cm2 Therefore, it is intended to produce an alive wound bed
(13.7–216.3 cm2) prior to the application, it was narrowed which is suitable for subsequent soft tissue reconstructions.
nearly 28.8 % (6.8–146.7 cm2) after the application. Once After 11.6 days on average, it was observed that wound
the wounds became ready for surgery, the following treat- surfaces of the patients were narrowed prominently. Rate of
ment methods were applied to the participants: split- such narrowing was 28.8 %. There are some studies with
thickness grafting (15 patients, 31.25 %), secondary su- similar results in the literature [16, 17]. The study performed
ture (9 patients, 18.75 %), full-thickness grafting (18 by Kılıç et al. [16] showed that 17 patient treated with
patients, 37.5 %), and flap (6 patients, 12.5 %) (Figs. 1, vacuum-assisted wound closure were followed for average
2 and 3). None of the patients suffered from vacuum- 16 days and approximately 30 % wound size reduction was
assisted wound closure treatment-related infection and achieved. Demir et al. [17] demonstrated that average dura-
hematoma. tion of treatment was 12.4 days and average wound size
reduction following treatment of 50 cases was 23 %. We
were able to close the wounds of only three patients
Discussion (18.75 %) with secondary suture following vacuum-
assisted wound closure treatment. With regard to the other
Satisfactory results established from vacuum-assisted patients, we had to perform a surgery for wound closure. In
wound closure method have proved that cases were selected the literature, this rate is 88.2 % and it has also been reported
properly. In particular, success rate is high in traumatic that no additional surgery is required following the applica-
cases. The vacuum-assisted treatment method has been used tion [16]. We believe that this rate was lower in our study, as
especially in open fracture cases as reported in the literature wound surfaces of the patients were relatively large.
[8, 9]. Some problems related to blood supply can be en- Average period of vacuum-assisted wound closure treat-
countered in diabetic wound cases. Success rate may be ment was 11.6 days and yet the period of the hospitalization
affected by some factors such as appropriate case selection was more than 1 month, considering the second surgeries
and suitable treatment plan [10, 11]. after application. Although this treatment method is more
expensive and restricts daily lives of the patients, it reduces
the costs caused by staying in the hospital for a long time,
when compared to traditional medical dressing and surgical
debridement methods. Flack et al. [18] created a Markov
model to compare costs. They demonstrated an overall
lower cost of care (US$52,830 versus US$61,757 per per-
son) for patients treated with vacuum-assisted wound clo-
sure therapy compared with advanced dressings.
No complication such as infection or hematoma was
observed during our study. Only four patients (8.3 %) suf-
fered from high pressure-related pain during the process and
these patients were given analgesic medicines.
As a result, it can be concluded that vacuum-assisted
Fig. 3 Vacuum assisted wound closure treatment was applied on the
wound closure method offers a faster and comfortable treat-
patient before flap, who was treated because of Type III tibia open ment option for wounds which cannot be closed on primary
fracture basis because of their size, as well as wounds of which
Indian J Surg (July–August 2013) 75(4):302–305 305
blood supply is insufficient. This treatment has more advan- 8. Halvorson J, Jinnah R, Kulp B, Frino J (2011) Use of vacuum-
assisted closure in pediatric open fractures with a focus on the rate
tages compared to traditional debridement and irrigation
of infection. Orthopedics 34(7):256–260
methods. We believe that the outcomes of vacuum-assisted 9. Eisenhardt SU, Momeni A, Iblher N, Penna V, Schmidt Y, Torio N,
wound closure treatment can be satisfactory with regard to Stark GB, Bannasch H (2010) The use of the vacuum-assisted
careful patient and case selection. closure in microsurgical reconstruction revisited: Application in
the reconstruction of the posttraumatic lower extremity. J Reconstr
Microsurg 26(9):615–622
10. Landsman A (2010) Analysis of the SNAP wound care system: a
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