Vacuum-assisted wound closure in vascular surgery – clinical and cost benefits in a developing country

Igor B Končar; Slobodan Cvetković; Marko Dragaš; Sinisa Pejkić; Goran Lazović; Igor Banzić; Marinko Zuvela; Miroslav Marković; Lazar Davidović

doi:10.2298/5208

Igor B Končar Clinic for Vascular and Endovascular Surgery of the Serbian Clinical Centre Medical Faculty, University of Belgrade
Slobodan Cvetković Clinic for Vascular and Endovascular Surgery of the Serbian Clinical Centre Medical Faculty, University of Belgrade
Marko Dragaš Clinic for Vascular and Endovascular Surgery of the Serbian Clinical Centre Medical Faculty, University of Belgrade
Sinisa Pejkić Clinic for Vascular and Endovascular Surgery of the Serbian Clinical Centre
Goran Lazović Medical Faculty, University of Belgrade Clinic for plastic and reconstructive surgery, Serbian Clinical Centre
Igor Banzić Clinic for Vascular and Endovascular Surgery of the Serbian Clinical Centre
Marinko Zuvela Medical Faculty, University of Belgrade Clinic for gastrointestinal diseases, Serbian Clinical Center
Miroslav Marković Clinic for Vascular and Endovascular Surgery of the Serbian Clinical Centre Medical Faculty, University of Belgrade
Lazar Davidović Clinic for Vascular and Endovascular Surgery of the Serbian Clinical Centre Medical Faculty, University of Belgrade

DOI: https://doi.org/10.2298/5208

Keywords: surgical wound infection, surgical wound dehiscence, vascular surgical procedures, vacuum, socioeconomic factors, treatment outcome,

Abstract

Background/Aim. Surgical and chronic wounds in vascular patients might contribute to limb loss and death. Vacuum-assisted closure (VAC) – Kinetic Concepts, Inc. (KCI), has been increasingly used in Western Europe and the USA clinical practice for 15 years. Advantages of this method are faster wound healing, wound approximation, lower wound related treatment costs and improved quality of life during treatment. Evidence related to the usage of VAC therapy in vascular patients and cost effectiveness of VAC therapy in a developing country are lacking. The aim of this study was to explore results of VAC therapy in vascular surgery comparing to conventional methods and to test cost effects in a developing country like Serbia. Methods. All patients with wound infection or dehiscence operated at the tertiary vascular university clinic in the period from January 2011 – January 2012, were treated with VAC therapy. The primary endpoint was wound closure, while secondary endpoints were hospital stay, the number of weekly dressings, costs of wound care, working time of medical personnel. The patients were divided into groups according to the wound type and location: wound with exposed synthetic vascular implant (25%), laparotomy (13%), foot amputation (29%), major limb amputation (21%), fasciotomy (13%). The results of primary and secondary endpoint were compared with the results of conventional treatment during the previous year. Results. There was one death (1/42, 2.38%) and one limb loss (1/12, 2.38%) in the VAC group, and 8 deaths (8/38, 21.05%) and 5 (5/38, 13.15%) limb losses in the patients treated with conventional therapy. In the VAC group there was one groin bleeding (1/12, 2.38%), one groin reinfection (1/12, 2.38%) and one resistance to therapy with a consequent limb loss. Costs of hospital stay (p < 0.001) and nursing time (p < 0.001) were reduced with VAC therapy in the group with exposed graft. Conclusion. VAC therapy is the effective method for care of complicated wounds in vascular surgery. Patients with infection of wound with the exposed synthetic graft significantly benefit form this therapy. Cost effectiveness of VAC therapy is applicable to a developing country scenario, however cautious selection of patients contributes to the effectiveness.

References

Fleischmann W, Becker U, Bischoff M, Hoekstra H. Vacuum sealing: indication, technique, and results. Eur J Orthop Surg Traumatol 1995; 5(1): 37−40.

Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacu-um-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 1997; 38(6): 553−62.

Argenta LC, Morykwas MJ. Vacuum-assisted closure: A new method for wound control and treatment: clinical experience. Ann Plast Surg 1997; 38(6): 563−76; discussion 577.

Renaud J. Postoperative drainage of wounds by means of nega-tive pressure. Ned Tijdschr Geneeskd 1959; 103: 1845−7.

Schultz GS, Sibbald GR, Falanga V, Ayello EA, Dowsett C, Harding K, et al. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen 2003; 11 Suppl 1: S1−28.

Albuquerque ML, Waters CM, Savla U, Schnaper HW, Flozak AS. Shear stress enhances human endothelial cell wound closure in vitro. Am J Physiol Heart Circ Physiol 2000; 279(1): 293−302.

Hamed O, Muck PE, Smith JM, Krallman K, Griffith NM. Use of vacuum assisted closure (VAC) therapy in treating lymphatic complications after vascular procedures: New approach for lymphoceles. J Vasc Surg 2008; 48(6): 1520−23, 1523.e1−4.

Dosluoglu HH, Loghmanee C, Lall P, Cherr GS, Harris LM, Dryjski ML. Management of early (<30 day) vascular groin infections using vacuum-assisted closure alone without muscle flap cov-erage in a consecutive patient series. J Vasc Surg 2010; 51(5): 1160−6.

Sörelius K, Wanhainen A, Acosta S, Svensson M, Djavani-Gidlund K, Björck M. Open Abdomen Treatment after Aortic Aneurysm Repair with Vacuum-assisted Wound Closure and Mesh-mediated Fascial Traction. Eur J Vasc Endovasc Surg 2013; 45(6): 588−94.

Vuerstaek JD, Vainas T, Wuite J, Nelemans P, Neumann MH, Veraart JC. State-of-the-art treatment of chronic leg ulcers: A randomized controlled trial comparing vacuum-assisted clo-sure (V.A.C.) with modern wound dressings. J Vasc Surg 2006; 44(5): 1029−37.