Vacuum-assisted closure of laparostomy wounds: a critical review of the literature.

Vacuum-assisted closure (VAC) reduces the burden for carers of laparostomy wounds but evidence from randomised trials is lacking. This review analyses the evidence for the VAC abdominal wound management system (KCI, San Antonio, TX) in the open abdomen. Three prospective studies provide level III evidence that VAC allows delayed primary fascial closure in the majority of these wounds up to 21 days after occurrence, but not where duration of VAC was less than 9 days or if vacuum pack techniques were used in place of VAC. Fistulae occurred in a minority of wounds complicated by multi-organ failure or sepsis and could not be attributed to VAC itself. Two retrospective analyses suggested VAC may reduce re-operation rate and length of stay in complex wounds. Whilst randomised controlled trials remain the gold standard of evidence for effectiveness of health care interventions, contemporaneous level III evidence supports the hypothesis that VAC increases the rate of primary fascial closure. Whilst enterocutaneous fistula formation is reported in the most complex of these wounds, there is no more evidence that these are consequential to as opposed to coincident with VAC use.