VAC therapy is effective in patients with acute traumatic wounds, orthopedic wounds and also partial thickness burns. In these wounds, VAC treatment promotes the formation of granulation tissue, improves perfusion of the wound and removes exudates, fluids and infectious materials. It helps in take of flap of skin in case of grafting. The recommended initial cycle in acute wounds is continuous type in the first 48 hours, after which intermittent therapy is advised (KCI, 2007). Intermittent therapy involves 5 minutes ‘on’ and 2 minutes ‘off’.
The pressure employed for these wounds is 125mmHg for GranuFoam dressing and 125-175mmHg for WhiteFoam dressing (KCI, 2007). In case of large exudates from the wounds, pressures may be increased by 25- 75mmHg until adequate fluid is removed and then tapered off. In tunneling wounds, continuous therapy may be given throughout the period of treatment. The wound dressings need to be changed atleast every 48-72 hours. In infected wounds, more frequent dressing changes may be needed. VAC therapy is instituted only after initial debridement. In case of orthopedic wounds, the therapy can be given even in the presence of orthopedic hardware.
However, orthopedicians must have a high suspicion index for osteomyelitis. Prior to the administration of VAC therapy, the ligaments, tendons, organs, nerves and blood vessels of the concerned area must be completely covered and protected either with muscle flap, thick layer of natural tissue, non-adherent porous material or bioengineered tissue (KCI, 2007). The VAC foam may be applied directly over the mesh or intact peritoneum. In case frank blood is seen in the canister or tubing, VAC therapy must be stopped and immediate efforts must be made to control active bleeding.