Vacuum-assisted closure (VAC)
has been an integral part of open
abdominal wound management
for the past decade and is sup-
ported by a substantial evidence
base. Utilising negative pressure
wound therapy through a sealed
foam dressing, VAC systems
protect wounds while promoting
perfusion, drawing wound edges
together, and removing tissue
debris and fluids.
Studies examining VAC
therapy (V.A.C.® Therapy™,
KCI, San Antonio, Tex) have
in a nutshell
second opinion
the verdict
There is no doubt VAC therapy
has enhanced open abdominal
wound management, and,
in light of this, its use has
spread to other fields including
orthopaedic and cardiothoracic
surgery. It eases the nursing
burden by facilitating wound
care, improves healing and
reduces sepsis. However, as
the authors highlight, it is not
risk free.
Although development of
enterocutaneous fistula in
the setting of VAC therapy for
laparostomy wound manage-
ment has not been reported
largely focused on trauma
patients. However, as in our
hospital, the authors increasingly
use this for laparostomy wound
management following surgery
for intra-abdominal sepsis. This
study specifically focused on
outcomes in this setting.
Over 16 months, 29 patients
received VAC therapy for open
abdominal wounds. Median
age was 60 (range 31-80 years)
and median duration of therapy
was 26 days (range 2-68). Lap-
arostomy was most frequently
indicated for abdominal sepsis,
visceral oedema, and raised
intra-abdominal pressure.
Ten patients died (34%) while
receiving VAC therapy and 19
(65.5%) required ICU care.
Six patients (20%) developed
intestinal fistulation, diagnosed
at a median of 20 days (range
2-50) from its commencement.
Four of these patients died
(66%), all from multi-organ
failure, which had been present
in five of the six patients prior to
VAC therapy.
as a significant complication in
earlier studies, observations at
our hospital support the authors’
conclusions that the incidence
may be higher in relation to
its use for abdominal sepsis.
However, in this study patients
would have suffered significantly
compromised bowel function
in relation to their multi-organ
failure, which largely pre-dated
institution of VAC therapy. This
would have rendered them
more susceptible to intestinal
leakage and fistulation. In
addition, three patients suffered
from inflammatory bowel
disease and were therefore
predisposed to develop fistulae.
Other risk factors put forward
include presence of abdominal
mesh, abdominal sepsis,
and presence of an intestinal
anastomosis.
Given the increased mortality
associated with this complica-
tion, further research is required
to examine factors contributing
to intestinal leakage. In the
meantime the authors are right
to suggest a cautious approach
with a timely reminder that VAC
therapy is never completely
without risk.
intestinal leakage following VAC therapy – caution required?Rao M, Burke D, Finan PJ, Sagar PM. The use of vacuum-assisted closure of abdominal wounds: a word of caution. Colorectal Dis 2007; 9: 266-68.
• VAC therapy is a well
established, evidenced-
based treatment for
laparostomy wounds
• Previous studies focus on
VAC complications in
abdominal trauma rather
than sepsis
• Further research is
warranted to investigate
whether VAC therapy
encourages fistula
formation.
Edward Fitzgerald
Austin G Acheson
Nottingham University Hospital
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