ABSTRACT
Wound complications involving large subcutaneous vessels can cause significant challenges for surgeons. Negative pressure wound therapy (NPWT) has been increasingly used for treating complex wounds in vascular surgery, including groin infections, either as a bridge to surgical closure or as a primary wound treatment modality. Although a growing body of evidence exists for managing various problematic wounds, such as diabetic foot ulcers and open abdominal wounds, the role of NPWT in wounds involving large blood vessels or wounds complicating infected vascular grafts has not been well defined. A multidisciplinary advisory panel reviewed the literature relevant to wounds related to vascular surgical procedures and complications, focusing on large subcutaneous or infected vascular conduits. The results supported by the literature and the clinical practice of the consensus panel suggested that NPWT can be a useful adjunct to the management of vascular groin infections and dehiscences but must be used with caution.
Subject(s)
Negative-Pressure Wound Therapy/methods , Peripheral Vascular Diseases/surgery , Surgical Flaps/blood supply , Surgical Wound Infection/prevention & control , Vascular Surgical Procedures/adverse effects , Administration, Topical , Anti-Infective Agents/administration & dosage , Diabetic Foot/complications , Diabetic Foot/therapy , Female , Groin/blood supply , Groin/surgery , Humans , Male , Occlusive Dressings , Practice Guidelines as Topic , Prosthesis-Related Infections/microbiology , Prosthesis-Related Infections/therapy , Surgical Flaps/microbiology , Surgical Wound Infection/drug therapy , Vascular Surgical Procedures/methods , Wound Healing/physiologyABSTRACT
A group of international experts met in May 2006 to develop clinical guidelines on the practical application of vacuum assisted closure (V.A.C.)+ therapy in deep sternal wound infections. Group discussion and an anonymous interactive voting system were used to develop content. The recommendations are based on current evidence or, where this was not available, the majority consensus of the international group. The principles of treatment for deep sternal wound infections include early recognition and treatment of infection. V.A.C. therapy should be instigated early, following thorough wound irrigation and surgical debridement. V.A.C. therapy in deep sternal wound infections requires specialist surgical supervision and should only be undertaken by clinicians with adequate experience and training in the use of the technique.
