Application Experience: Refractory Wound Management With Vacuum-assisted Closure

BackgroundChronic ulcer is commonly seen in surgical word,such as decubital ulcer,diabetic foot,vascular inflammatory ulcer,chronic ulcer with osteomyelitis,and so on.The traditional saline-wet-to-dry dressings are used to treat the skin and soft refractory wound to gain a proliferation of the granulation tissue for decades of years.It can even result in worsening soft tissue injury and may make important tissue uncovered,such as tendon necrosis and osteomyelitis.Patients are suffering at the time of dressing change which may frequently happen.The doctor has to spend a lot of time in changing the dressings.An advanced therapy was needed urgent for both doctor and patient.The vacuum-assisted closure therapy was initiated by Doctor Fleischmann in 1993, and VAC was used in infection wound and got great effect.Argenta and Morykwas provide the basis for experimental and clinical medicine in 1997.They testify that VAC therapy can heal the wound quickly,including the refractory wound.Professor Huade Qiu got great research achievements on VAC therapy in china in 1994.It made a prominence contribution in granulation proliferation and had been used commonly in many departments like general surgery,plastic surgery,and department of orthopaedics ever since. We made a retrospective of vacuum-assisted closure therapy in treating the skin and soft tissue chronic wound from January 2007.MethodsFrom January 2007 to December 2008,a total of 23 patients with skin and soft tissue chronic wound,which was treated by traditional saline-wet-to-dry dressing's therapy for more than 1 month but didn't turn better,were treated in our department.All patients were followed up for 2-12 months.We recorded each patient's wound before and after the treatment,the wound secretion was collected for germiculture before and after the treatment,the times VAC used,the time they spent,and their satisfaction to the very treatment.Results1.The average times VAC used is 2.7.The average time they spent in hospital is 21 days.2.61%of the wounds finally achieved healing within three times of VAC;it is an effective treatment in treating the chronic wound.3.87%of the wounds finally achieved healing.13%of the wounds left are there diabetic feet,one of them can't adapt operation,and others experienced amputations and transferred to another section.4.All the patients have not occurred complications.ConclusionsVacuum-assisted closure therapy can avoid cross-contamination,heal the wound quickly,reduce the time spent in hospital,decrease the patient's pain,and the most important is the refractory wound achieved healing.VAC therapy is a convenient and effective treatment in treating the skin and soft tissue chronic wound.