[V.a.C.-therapy in abdominal surgery - experiences, limits and indications].
Compared to other surgical disciplines the significance of V.A.C.-therapy is rarely noticed in abdominal surgery. This may be due to uncertainty in defining clear indications or lack of technical know-how.


METHODS
We report on five selected septic cases in abdominal surgery without clearly defined indications for V.A.C.-therapy (ischiorectal abscess, perforation in Crohn's disease, pelvic abscess due to perforation caused by rectal carcinoma, abdominal compartment syndrome, anastomotic leak after rectal resection).


RESULTS
Regarding the individual aspects of indication, V.A.C.-therapy could be used successfully in the demonstrated cases. Under the palliative aspect, V.A.C.-therapy on a malignant wound bed allowed an early treatment with chemotherapy.


CONCLUSIONS
According to the literature dealing with V.A.C.-therapy, enterocutaneous fistulas, exposed viscera, enteral surfaces as well as malignancy in the wound bed are considered to be contraindications for the method. Reffering to our observations, these diagnoses should not be strictly regarded as contraindications. Elaboration of clear guidelines that point out clearly defined indications for V.A.C.-therapy should be the goal for the future.
Rexer
M
M
Klinikum Fürth, Chirurgische Klinik 1, Fürth. martin.rexer@tiscali.de
Ditterich
D
D
Rupprecht
H
H
D000005:Abdomen / Q000601:surgery*; D018784:Abdominal Abscess / Q000601:surgery*; D000328:Adult; D003646:Debridement / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008838:Microcomputers; D008875:Middle Aged; D009779:Occlusive Dressings; D010166:Palliative Care; D010538:Peritonitis / Q000601:surgery*; D011140:Polyurethanes; D012004:Rectal Neoplasms / Q000601:surgery; D012086:Reoperation; D025321:Surgery, Computer-Assisted / Q000295:instrumentation; D015503:Surgical Sponges; D013529:Surgical Wound Dehiscence / Q000601:surgery; D013530:Surgical Wound Infection / Q000601:surgery*; D013536:Suture Techniques / Q000295:instrumentation*; D014618:Vacuum; D014945:Wound Healing / Q000502:physiology
D011140:Polyurethanes