Mechanics of wound healing and importance of Vacuum Assisted Closure((R)) in urology

University of Illinois Springfield, Спрингфилд, Florida, United States
The Journal of Urology (Impact Factor: 4.47). 06/2005; 173(5):1463-70. DOI: 10.1097/01.ju.0000157339.05939.21
Source: PubMed


We discuss the mechanisms of wound healing and our experience with the Vacuum Assisted Closure device (Kinetic Concepts, Inc., San Antonio, Texas) for complex urogenital wounds.
The literature obtained from a Medline search on wound healing, wound failure and vacuum assisted closure was reviewed. In addition, we reviewed our experience with negative pressure wound therapy.
Wound healing is a complex interaction between the reticuloendothelial and immune systems, in addition to correctable internal and external factors. Understanding the healing process improves outcomes and decreases patient morbidity. Negative pressure wound therapy has hastened wound healing and it adds significant improvement in the arsenal of choices available.
Vacuum Assisted Closure is a therapeutic alternative that complements surgical and medical intervention in patients with complex wounds.

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    • "Secondly, VAC results in increased local interleukin-8 and vascular endothelial growth factor (VEGF) concentrations, which may trigger the accumulation of neutrophils and angiogenesis (3). With the cyclical application of subatmospheric pressure, VAC alters the cytoskeleton of cells in the wound bed, triggering a cascade of intracellular signals that increase the rates of cell proliferation and division, and subsequent formation of granulation tissue (4). "
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    ABSTRACT: Severe traumatic wounds are challenging to manage during surgery. The introduction of vacuum-assisted closure (VAC) is a breakthrough in wound management. The aim of the present study was to investigate the effect of VAC on cytokines in wounds during the management of severe traumatic wounds following initial debridement. VAC and conventional wound care (CWC) were independently applied to severe traumatic wounds on pigs. The expression levels of intercellular adhesion molecule-1 (ICAM-1), migration inhibitory factor (MIF), vascular endothelial growth factor (VEGF), basic fibroblast growth factor, collagen I and human fibroblast collagenase 1 were detected by quantitative polymerase chain reaction and western blotting. VAC significantly increased the expression of ICAM-1, MIF, VEGF and collagen I compared with that induced by CWC at the protein and mRNA levels. Therefore, the results of the present study indicate that VAC therapy is an effective method for treating severe traumatic wounds, as it increases the expression of cytokines in wounds. VAC significantly increases the expression of ICAM-1, MIF, VEGF and collagen I to manage severe traumatic wounds.
    Full-text · Article · May 2014 · Experimental and therapeutic medicine
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    • "Further conservative treatment proved to be ineffective and a great amount of fistula exudates led to the increase of the wound size as well as the development of inflammation and necrosis. Introduction of VAC therapy appeared to be the only alternative for those patients, and it was initiated despite the controversies concerning VAC therapy use for intestinal fistulas [18]. It has been suggested that VAC therapy used for complex wounds with directly exposed intestinal loops might increase the risk of new fistula formation [19, 20]. "
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    ABSTRACT: Vacuum-assisted closure (VAC) therapy is a widely acknowledged method for chronic and traumatic wound healing. The feasibility of VAC therapy used for the treatment of intestinal fistulas is still a subject of debate. Complex postoperative wounds pose significant therapeutic problems, especially when there are several fistula openings in the wound area and other sites, usually at the site of previous drains. This paper describes the treatment of three patients in a critical condition, with complex postoperative wounds complicated by multiple fistulas. Vacuum-assisted closure therapy was based on effective drainage of the biggest fistula opening and ensuring conditions promoting the healing process of other fistulas and the wound. A considerable improvement in general condition and wound healing was noted within 2-4 weeks and both the number of fistulas and the volume of excreted contents decreased. After 5-7 weeks a significant improvement in wound healing was observed in all patients. Once the general condition of all patients was considered satisfactory (2-6 months), they underwent surgery aimed at restoration of the digestive tract continuity.In our opinion, VAC therapy used for the treatment of postoperative wounds with multiple fistulas in the wound area and other sites should aim mainly at the improvement of patients' general condition, limitation of the number of fistulas as well as accelerated wound healing. This may lead to formation of one stoma-type fistula, which can be dressed and cared for by patients until the continuity of the digestive tract has been surgically restored.
    Full-text · Article · Sep 2011 · Videosurgery and Other Miniinvasive Techniques / Wideochirurgia i Inne Techniki Malo Inwazyjne
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    • "The presence of malignant tissue is generally viewed as a contraindication for VAC, as it stimulates cell growth [1]. There are only three reports of VAC in urology [2-4]. No treatment of intraabdominal urinary leakage, a rare but severe event in urinary diversion [5], has been reported to date. "
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    ABSTRACT: Vacuum-assisted closure (VAC) is an acknowledged method of treating wound healing disorders, but has been viewed as a contraindication in therapy of intraabdominal fistulas. We present the case of an 83-year old patient with ureteroileal anastomotic insufficiency following cystectomy and urinary diversion by Bricker ileal conduit due to urothelial bladder cancer. After developing an open abdomen on the 16th postoperative day a leakage of the ureteroileal anastomosis appeared that cannot be managed by surgical means. To stop the continued leakage we tried a modified VAC therapy with a silicon covered polyurethane foam under a suction of 125 mmHg. After 32 days with regularly changes of the VAC foam under general anesthesia the fistula resolved without further problems of ureteroileal leakage. We present the first report of VAC therapy successfully performed in urinary tract leakage after surgical treatment of bladder cancer. VAC therapy of such disorders requires greater care than of superficial application to avoid mechanical alterations of internal organs but opens new opportunities in cases without surgical alternatives.
    Full-text · Article · Feb 2007 · World Journal of Surgical Oncology
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