New Applications for Wound-Healing Device
From Clinical Update, Fall 2004
Abstract: The Vacuum-Assisted Closure (V.A.C.®) device developed at Wake Forest is now being used worldwide to promote healing in large abdominal wounds, fight infection following open heart surgery and enhance healing of burns. More than a million Americans now are using the device as part of their home therapy.
Each year, hundreds of physicians come to Wake Forest Baptist Medical Center to learn to use the Vacuum-Assisted Closure (V.A.C.®) wound-healing device. Developed at Wake Forest Baptist by Louis C. Argenta, MD, professor and chairman of the plastic and reconstructive surgery department, and Michael J. Morykwas, PhD, assistant professor of plastic and reconstructive surgery, it is now accepted throughout the world as a major advance in wound-care treatment.
“Our clinical and laboratory efforts have expanded the use of this device for an extremely wide group of patients, and this experience has achieved international recognition,” said Argenta. “In addition, all of the physicians in our group have lectured throughout the world on this topic. Further research in this procedure examines the application of the V.A.C. device to burns, a new field of research currently being pursued by multiple investigators throughout the world.”
V.A.C. applications have grown to include larger, more severe injuries. Argenta says the device is now being used to treat large abdominal wounds like those due to traumas suffered in automobile accidents.
“When the swelling due to trauma prevents the belly from being closed during surgery, infection can spread everywhere,” said Argenta. “We pioneered the use of a large sponge applied to the abdominal cavity to remove enough fluid to reduce the swelling and allow surgeons to repair the injury faster.”
In open heart surgery cases, it is not uncommon for infection to occur at the sternum after it is split open to expose the heart. The V.A.C. device is being used at institutions in Europe as the standard of care to treat infection at this site. When the V.A.C. is used in this instance, dressings to the wound are changed once a day rather than the customary three times a day.
V.A.C. therapy was approved by the Food and Drug Administration in 1995 to help treat a wide range of wounds including partial thickness burns, diabetic ulcers, bedsores, dehisced surgical incisions, flaps, grafts, traumatic wounds and other non-healing wounds. The device is used 70 percent of the time for acute wounds, trauma to the lower extremities and injuries to the head.
During the V.A.C. procedure, surgeons place a sponge into the wound and cover it with an occlusive dressing. A suction device is applied and removes fluid from the wound. This procedure reduces bacteria in the wound, draws out stagnant toxins and stimulates new blood flow, decreasing the wound healing time dramatically.
In 2000, the Health Care Financing Administration (HCFA) approved a new Medicare Part B reimbursement code that allows the use of V.A.C. therapy at home. According to its manufacturer, Kinetic Concepts Inc. (KCI), more than one million Americans now have in-home access to the V.A.C. device. This creates potential cost savings resulting from:
- Patients spending less time in hospital because they can continue treatment at home
- Better healing that can reduce the demand on other medical modalities
- Reduced direct nursing costs because V.A.C. dressings are generally changed every 48 hours, compared to at least once a day for traditional dressings
VAC® Device Minimizes Wound Progression and Decreases Swelling in Second-degree Hand Burns
According to a study at Wake Forest Baptist Medical Center, use of the Vacuum-Assisted Closure (V.A.C.®) device on second-degree hand burns appears to minimize wound progression and decrease swelling.
Plastic surgeon Joseph A. Molnar, MD, PhD, FACS, presented the interim results of the study at the American Burn Association’s 36th Annual meeting in Vancouver, Canada earlier this year.
The results showed significant improvement at three days and even greater improvement at five days.
“Present management of the burn wound is primarily directed at preventing infection but does little to prevent burn wound progression or the inflammatory response,” said Molnar. “This study was designed to evaluate the effect of negative pressure on burn wound progression, edema and hand function when applied to acutely burned hands.”
The Wake Forest Baptist Medical Center Burn Center is one of only two burn centers in North Carolina. It provides acute and chronic burn care in the western part of the state.
The study design was multi-center and Web-based. Sites included the University of Washington, Seattle, the University of Florida, Gainesville and academic medical centers in Vancouver and Edmonton, Canada, Augusta, Ga., Portland, Ore., and Mobile, Ala.
A total of 23 adult patients were evaluated at this stage in the study.