Abstract
The use of sub-atmospheric pressure dressings, available commercially as the vacuum-assisted closure (VAC) device, has been shown to be an effective way to accelerate healing of various wounds. The optimal sub-atmospheric pressure for wound healing appears to be approximately 125mm Hg utilizing an alternating pressure cycle of 5 minutes of suction followed by 2 minutes off suction. Animal studies have demonstrated that this technique optimizes blood flow, decreases local tissue edema, and removes excessive fluid from the wound bed. These physiologic changes facilitate the removal of bacteria from the wound. Additionally, the cyclical application of sub-atmospheric pressure alters the cytoskeleton of the cells in the wound bed, triggering a cascade of intracellular signals that increases the rate of cell division and subsequent formation of granulation tissue. The combination of these mechanisms makes the VAC device an extremely versatile tool in the armamentarium of wound healing. This is evident in the VAC device’s wide range of clinical applications, including treatment of infected surgical wounds, traumatic wounds, pressure ulcers, wounds with exposed bone and hardware, diabetic foot ulcers, and venous stasis ulcers. VAC has also proven useful in reconstruction of wounds by allowing elective planning of the definitive reconstructive surgery without jeopardizing the wound or outcome. Furthermore, VAC has significantly increased the skin graft success rate when used as a bolster over the freshly skin-grafted wound. VAC is generally well tolerated and, with few contraindications or complications, is fast becoming a mainstay of current wound care.
Similar content being viewed by others
Notes
The use of trade names is for product identification purposes only and does not imply endorsement.
References
Hopf HW, Humphrey L, Puzziferri N, et al. Adjuncts to preparing wounds for closure: hyperbaric oxygen, growth factors, skin substitutes, negative pressure wound therapy (vacuum-assisted closure). Foot Ankle Clin. 2001 Dec; 6 (4): 661–82
Fleischmann W, Strecker W, Bombelli M, et al. Vacuum sealing as a treatment of soft tissue damage in open fractures [in German]. Unfallchirurg. 1993; 96 (9): 488–92
Fleischmann W, Lang E, Klinzl L. Vacuum assisted wound closure after dermatofasciotomy of the lower extremity [in German]. Unfallchirurg. 1996; 99 (4): 283–7
Fleischmann W, Russ M, Marquardt C. Closure of defect wounds by combined vacuum sealing with instrumental skin expansion [in German]. Unfallchirurg. 1996; 99 (12): 970–4
Fleischmann W, Lang E, Russ M. Treatment of infection by vacuum sealing [in German]. Unfallchirurg. 1997; 100 (4): 301–4
Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997; 38 (6): 563–77
Morykwas MJ, Argenta LC, Shelton-Brown EI, et al. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg. 1997; 38 (6): 553–62
Urschel JD, Scott PG, Williams HTG. The effect of mechanical stress on soft and hard tissue repair: a review. Br J Plast Surg. 1988; 41: 182–6
Olenius M, Dalsgaard C, Wickman M. Mitotic activity in the expanded human skin. Plast Reconstr Surg. 1993; 91: 213–6
Ilizarov GA. The tension-stress effect on the genesis and growth of tissues: part I. the influence of stability and fixation on soft-tissue preservation. Clin Orthop. 1989; 238: 249–81
Saxena V, Hwang CW, Huang S, et al. Vacuum-assisted closure: microdeformations of wounds and cell proliferation. Plast Reconstr Surg. 2004; 114 (5): 1086–96
Robson MC, Stenberg BD, Heffers JP. Wound healing alterations caused by infection. Clin Plast Surg. 1990; 17: 485–92
Krizek TJ, Robson MC. The evolution of quantitative bacteriology in wound management. Am J Surg. 1975; 130: 579–84
Robson MC, Heggers JP. Delayed wound closure based on bacterial counts. J Surg Oncol. 1970; 2: 379–83
Robson MC, Heggers JP. Bacterial quantification of open wounds. Mil Med. 1969; 134: 19–24
DeFranzo AJ, Argenta LC, Marks MW, et al. The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone. Plast Reconstr Surg. 2001 Oct; 108 (5): 1184–91
Gwan-Nulla DN, Casal RS. Toxic shock syndrome associated with the use of the vacuum assisted closure device. Ann Plast Surg. 2001; 47: 552–4
Clare MP, Fitzgibbons TC, McMullen ST, et al. Experience with the vacuum assisted closure negative pressure technique in the treatment of non-healing diabetic and dysvascular wounds. Foot Ankle Int. 2002; 23 (10): 896–901
Armstrong DG, Attinger CE, Boulton AJ, et al. Guidelines regarding negative wound therapy (NPWT) in the diabetic foot. Ostomy Wound Manage. 2004; 50 (4 Suppl. 4B): 3S–27S
Byrd HS, Spicer TE, Cierny G. Management of open tibial fractures. Plast Reconstr Surg. 1985; 76: 719–30
Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Clin Plast Surg. 1986; 13 (4): 619–20
Joseph E, Harried CA, Bergman S, et al. A prospective randomized trial of vacuum-assisted closure versus standard therapy of chronic nonhealing wounds. Wounds. 2000; 12 (3): 60–7
Edington MT, Brown KR, Seabrook BR, et al. A prospective randomized evaluation of negative pressure wound dressing for diabetic foot wounds. Ann Vase Surg. 2003; 17 (6): 645–9
McCallon SK, Knight CA, Valiulus JP, et al. Vacuum-assisted closure versus saline-moistened gauze in the healing of postoperative diabetic foot wounds. Ostomy Wound Manage. 2000; 46: 28–32
Ford CN, Reinhard ER, Yeah D, et al. Interim analysis of a prospective randomized trial of vacuum assisted closure versus the Healthpoint system in the management of pressure ulcers. Ann Plast Surg. 2002; 49: 55–61
Armstrong DG, Lavery AL, Abu-Rumman P, et al. Outcomes of sub atmospheric pressure wound dressing therapy on wounds of the diabetic foot. Ostomy Wound Manage. 2002; 48: 64–8
Edmonds M, Bates M, Doxford M, et al. New treatments in ulcer healing and wound infection. Diabetes Metab Res Rev. 2000; 16 Suppl. 1: S51–4
Philbeck TE, Whittington KT, Millsap MIL et al. The clinical and cost effectiveness of externally applied negative pressure wound therapy in the treatment of wounds in home healthcare Medicare patients. Ostomy Wound Manage. 1999; 45 (11): 41–50
Smith N. The benefits of VAC therapy in the management of pressure ulcers. Br J Nurs. 2004; 13 (22): 1359–65
Wanner MB, Schwarzl F, Strub B, et al. Vacuum-assisted wound closure for cheaper and more comfortable healing of pressure sores: a prospective study. Scand J Plast Reconstr Surg Hand Surg. 2003; 37 (1): 28–33
Greer SE, Duthie E, Cartolano B, et al. Techniques for applying subatmospheric pressure dressing to wounds in difficult regions of anatomy. J Wound Ostomy Continence Nurs. 1999; 26: 250–3
Mullner T, Mrkonjic L, Kwasny O, et al. The use of negative pressure to promote the healing of tissue defects: a clinical trial using the vacuum sealing technique. Br J Plast Surg. 1997; 50: 194–9
Schneider AM, Morykwas MJ, Argenta LC. Anew and reliable method of securing skin grafts to the difficult recipient bed. Plast Reconstr Surg. 1998; 102 (4): 1195–8
Espensen EH, Nixon BP, Lavery LA, et al. Use of subatmospheric (VAC) therapy to improve bioengineered tissue grafting in diabetic foot wounds. J Am Podiatr Med Assoc. 2002; 92: 395–7
Attinger C, Hopf H, Marks MW, et al. New approaches to difficult wound healing challenges. Panel at the 73rd American Society for Plastic Surgery; 2004 Oct 9–13; Philadelphia (PA)
Scherer LA, Shiver S, Chang M, et al. The vacuum assisted closure device: a method of securing skin grafts and improving graft survival. Arch Surg. 2002; 137: 930–4
Molnar JA, DeFranzo AJ, Marks MW. Single-stage approach to skin grafting the exposed skull. Plast Reconstr Surg. 2000; 105 (1): 174–7
Genecov DG, Schneider AM, Morykwas MJ, et al. A controlled subatmospheric pressure dressing increases the rate of skin graft donor site reepithelialization. Ann Plast Surg. 1998; 40 (3): 219–25
Howard M, Attinger CE, Cooper P. Soft tissue strategies around the Ilizarov [abstract]. American Orthopedic Foot and Ankle Society 19th Annual Summer Meeting; 2003 Jun 27–29; Hilton Head (SC)
Morykwas MJ, Faler BJ, Pearce DJ, et al. Effects of varying levels of subatmospheric pressure on the rate of granulation tissue formation in experimental wounds in swine. Ann Plast Surg. 2001; 47 (5): 547–51
Webb LX. New techniques in wound management: vacuum-assisted wound closure. J Am Acad Orthop Surg. 2002; 10: 303–11
Acknowledgments
The authors would like to acknowledge Daniel Lane as the medical photographer of this manuscript. No sources of funding were used to assist in the preparation of this manuscript. Dr Attinger is on the Kinetic Concepts, Inc. speakers bureau.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Venturi, M.L., Attinger, C.E., Mesbahi, A.N. et al. Mechanisms and Clinical Applications of the Vacuum-Assisted Closure (VAC) Device. Am J Clin Dermatol 6, 185–194 (2005). https://doi.org/10.2165/00128071-200506030-00005
Published:
Issue Date:
DOI: https://doi.org/10.2165/00128071-200506030-00005