Evaluation of low-cost custom made VAC therapy compared with conventional wound dressings in the treatment of non-healing lower limb ulcers in lower socio-economic group patients of Kashmir valley

Abstract

Background: Negative-pressure wound therapy is a technique to achieve wound healing in patients with non-healing wounds of the lower limb; vacuum-assisted closure (VAC) therapy is a technique to accelerate the healing of non-healing ulcers that fail to heal on their own (primary healing) (Plast Reconstr Surg 117:193-209S, 2006). Delayed wound healing or non-healing of ulcers is a significant health problem, particularly in older adults. The efficacy of VAC dressings has been demonstrated in several randomized controlled studies, which have shown significantly faster wound healing rates compared to conventional wound therapy (Lancet 366:1704-10, 2005; J Wound Care 17:426-32, 2008). However, commercially available VAC is costly. The aim of using custom made VAC was decided by our team due to lower socio-economic status of patients taken for study who could not have afforded charges of commercially available VAC unit.

Objective: Objective was to evaluate VAC therapy compared with conventional dressings in the treatment of non-healing lower limb ulcers in lower socio-economic patients.

Methods: Sixty patients of lower socio-economic status aged between 40 and 70 were prospectively studied for non-healing ulcers Wagner grade 2 or 3 and randomized into 2 groups. VAC dressing was kept for over a period of 2-7 weeks. Ulcers were treated until the wound closed spontaneously, surgically or until completion of the 50-day period, whichever was earlier.

Results: By seventh week, discharge disappeared in 96 % in VAC and only 54 % in conventional dressing group. Granulation tissue appeared in 100 % of patients in VAC group and only 63 % in conventional dressing group. The patients treated with VAC dressing in our study showed comparable wound reduction capabilities with an average wound size reduction of 56 % in comparison to conventional dressing group which had average wound size reduction of 29 %. Majority of wounds in VAC group got closed in 7 weeks. Patient satisfaction was excellent in the majority of patients in VAC group compared to those in conventional dressing group.

Conclusion: The application of VAC™ had shown good results in our study.

Fig. 1

Instruments required for VAC. Dressing set, suction tube with side pores, Ioban and sterile foam

Fig. 2

VAC applied to patient with non-healing ulcer following fasciotomy. Look at the wrinkles on Ioban following active suctioning of VAC. A well-covered foam and mesentery around suctioning tube

Fig. 3

In-hospital suctioning unit for VAC. Pressure gauge for monitoring VAC pressure

Fig. 4

Gender distribution of patients in VAC group

Fig. 5

Gender distribution in conventional dressing group

Fig. 6

Non-healing stump after injury due to RTA. Stump could not be closed by routine daily dressing. Patient was referred to our institute from a peripheral hospital

Fig. 7

Same patient after application of first VAC

Fig. 8

After 4 weeks of VAC application: wound showed a significant improvement during the course of VAC treatment. The wound was dry with good granulation tissue and significant decrease in size in comparison to initial size of wound before application of VAC

Fig. 9

After 6 weeks of VAC application: further decrease in size of wound. Wound was dry with no signs of infection. During course of VAC application, gentle ROM for knee was advised to the patient

Fig. 10

Follow-up of patient in OPD 1 month after discharge. Look at small callosity over the stump due to use of prosthesis

Fig. 11

Follow-up of patient in OPD 1 month after discharge. complete healing of ulcer is noted.

Fig. 12

Descriptive statistics of final closure in VAC group

Fig. 13

Descriptive statistics of final closure in VAC group

Fig. 14

Non-healing ulcer after Achilles tendon repair. Patient came to us with active discharge, with uncontrolled blood sugar. Wound culture was positive for pseudomonas. Initial minor debridement followed by copious lavage with saline was done in emergency OT. VAC was applied on first post-operative day

Fig. 15

VAC in progress for the same patient. Wrinkles over Ioban are visible after application of negative pressure. Sugar got controlled after 5 days of application of VAC

Fig. 16

Healed ulcer after 4 weeks