The Effects of Varying Degrees of Pressure Delivered by Negative-Pressure Wound Therapy on Skin Perfusion

Timmers, Michael S.; Cessie, Saskia le; Banwell, Paul E.; Jukema, G. N.

doi:10.1097/01.sap.0000187182.90907.3d

Cited by 223 publications

(187 citation statements)

References 16 publications

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“…Timmers y col. evaluaron el efecto del tratamiento con presión negativa sobre el flujo sanguíneo en piel sana de 10 voluntarios humanos (8). El flujo se quintuplicó con la espuma de poliuretano (GranuFoam) y se triplicó con la de polivinilalcohol (WhiteFoam) con presiones negativas de 300 mm Hg.…”

Section: Discussionunclassified

Terapia VAC® en traumatismo grave de pierna izquierda

Pérez

2010

Cir. plást. iberolatinoam.

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ResumenLas fracturas abiertas de los miembros inferiores debidas a traumatismos de alta energía, suponen un reto terapéutico debido a la gravedad de las heridas, la afectación importante de varios tipos de tejidos y a la complejidad de los procedimientos quirúrgicos necesarios para su tratamiento que pueden llegar hasta complicadas técnicas microquirúrgicas mediante colgajos libres, quedarse en un colgajo muscular o compuesto, pediculado, o bien mantener una actitud más conservadora. Esto último es posible desde la aparición en los años 90 de una nueva técnica, la Terapia Vacuum Assisted Closure ( Terapia VAC ® ), que se basa en la aplicación de vacío o presión negativa sobre la herida.Este recurso terapéutico permite una pauta más conservadora de tratamiento de estas fracturas tan complejas, reduciendo los riesgos, la morbilidad y minimizando las complicaciones.Presentamos un caso de fractura del miembro inferior izquierdo, abierta, compleja, con policontusión y aplastamiento, que creemos muy demostrativo del excelente resultado clínico que se puede obtener mediante el empleo de la terapia con presión negativa con el Sistema VAC ®.* Cirujano Plástico. Servicio de Cirugía Plástica y Reparadora, Hospital Central de la Defensa Gómez Ulla, Madrid, España Palabras clave Fracturas abiertas, Heridas, Sistema de Presión Negativa, Miembro inferior. Código numérico 15117-152-157 AbstractThe open fractures of the lower limb caused by high energy trauma, poses a major surgical challenge. These wounds have a significative complexity, with multiple lesions involving bone, muscle, nerves, vessels, skin and subcutaneous tissues. There are a wide spectrum of reconstructive options for the treatment, most of them requiring complex microsurgical transfers of autologous tissue. The Vacuum Assisted Therapy (VAC ®) has become a most useful tool for the plastic surgeon since the last century's 90 decade. Based in the application of negative pressure to the wound bed, promotes healing by granulation tissue formation, keeping the wound clean and avoiding bacterial colonization. Used as a primary method or in combination with others, VAC® therapy allows more conservative options in the treatment of these wounds, lowering the incidence of complications and avoiding the need of demanding and high cost surgical interventions. We describe the application of the VAC® therapy in a clinical case with complex lower limb open fracture and crush injury, showing its efficacy.

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Section: Discussionunclassified

Terapia VAC® en traumatismo grave de pierna izquierda

Pérez

2010

Cir. plást. iberolatinoam.

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“…These claims are only in part supported by evidence. Contradictory data exist on the increase of local tissue perfusion [84,84]. An advantage in edema reduction rests on weak evidence [85].…”

Section: Moisture Balancementioning

confidence: 99%

Evidence‐based topical management of chronic wounds according to the T.I.M.E. principle

Klein

Schreml

Dolderer

et al. 2013

J Deutsche Derma Gesell

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SummaryThe number of patients suffering from chronic wound healing disorders in Germany alone is estimated to be 2.5-4 million. Therapy related expenses reach 5-8 billion Euros annually. This number is partially caused by costly dressing changes due to non-standardized approaches and the application of non-evidence-based topical wound therapies. The purpose of this paper is to elucidate a straightforward principle for the management of chronic wounds, and to review the available evidence for the particular therapy options. The T.I.M.E.-principle (Tissue management, Inflammation and infection control, Moisture balance, Epithelial [edge] advancement) was chosen as a systematic strategy for wound bed preparation. Literature was retrieved from the PubMed and Cochrane Library databases and subjected to selective analysis.Topical wound management should be carried out according to a standardized principle and should further be synchronized to the phases of wound healing. Despite the broad implementation of these products in clinical practice, often no benefit exists in the rate of healing, when evaluated in meta-analyses or systematic reviews. This insufficient evidence is additionally limited by varying study designs. In case of non-superiority, the results suggest to prefer relatively inexpensive wound dressings over expensive alternatives. Arbitrary endpoints to prove the effectiveness of wound dressings, contribute to the random use of such therapies. Defining rational endpoints for future studies as well as the deployment of structured therapy strategies will be essential for the economical and evidence-based management of chronic wounds.

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“…However, there have been reports regarding the application of higher negative pressures (450-600 mmHg) (Morykwas et al, 2001). Timmers et al (2005) believe that the negative pressure should be selected according to the density of the wound tissue -for dense tissue, a relatively higher negative pressure (300-400 mmHg) should be selected, while for loose tissue, a lower negative pressure (125-130 mmHg) is more suited. There are currently no reports regarding VAC treatment for seawaterimmersed wounds.…”

Section: Introductionmentioning

confidence: 99%

Application of vacuum-assisted closure in seawater-immersed wound treatment under different negative pressures

Cao¹,

Peng²,

Sun³

et al. 2015

Genet. Mol. Res.

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ABSTRACT. The therapeutic effect of vacuum-assisted closure (VAC) has been confirmed in many types of complex wounds, but there are few relevant reports regarding seawater-immersed wounds. The aim of this study was to determine the effect of VAC on seawater-immersed wound healing under different negative pressures and explore the optimal negative pressure value. Four purebred miniature pigs were used as the experimental animal models. Four acute, symmetrical wounds were made on each side of the spine and designated as the experimental group (wounds with 2 h of seawater immersion) and the control group (wounds without seawater immersion). Wounds were divided into a conventional dressing group and 3 further groups with different VAC therapies (negative pressure at either 120, 180, or 240 mmHg). The extent of wound healing, and speed of granulation growth and re-epithelialization were measured. Bacterial flora distribution in the wounds was observed, and fibronectin levels in the exudate of the wounds were tested. Results showed that seawater immersion aggravated (2015) wound injury and that VAC therapy with 180 mmHg negative pressure induced the fastest epidermis migration, obvious edema elimination, significant capillary proliferation, and the highest level of fibronectin, and that in wounds, the proportion of Gram-negative bacteria tended to decrease and that of Gram-positive bacteria tended to increase. Our results show that VAC promotes seawater-immersed wound healing and that 180 mmHg negative pressure may be optimal for wound healing.

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The Effects of Varying Degrees of Pressure Delivered by Negative-Pressure Wound Therapy on Skin Perfusion

Cited by 223 publications

References 16 publications

Terapia VAC® en traumatismo grave de pierna izquierda

Terapia VAC® en traumatismo grave de pierna izquierda

Evidence‐based topical management of chronic wounds according to the T.I.M.E. principle

Application of vacuum-assisted closure in seawater-immersed wound treatment under different negative pressures

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