New techniques in wound management: vacuum-assisted wound closure.

Vacuum-assisted wound closure (VAC) is a wound management technique that exposes the wound bed to negative pressure by way of a closed system. Edema fluid is removed from the extravascular space, thus eliminating an extrinsic cause of microcirculatory embarrassment and improving blood supply during this phase of inflammation. In addition, the mechanical tension from the vacuum may directly stimulate cellular proliferation of reparative granulation tissue. Orthopaedic indications for VAC include traumatic wounds after débridement, infection after débridement, and fasciotomy wounds for compartment syndrome. VAC also can be used as a dressing for anchoring an applied split-thickness skin graft. The technique is contraindicated in patients with thin, easily bruised or abraded skin; those with neoplasm as part of the wound floor; and those with allergic reactions to any of the components that contact the skin. Clinical experience with the technique has resulted in a low incidence of minor, reversible irritation to surrounding skin and no major complications. Further experience is required, as well as clinical and basic research, to define optimal indications and benefits compared with traditional methods of wound management.