Vacuum-assisted closure (VAC) therapy in the management of wound infection following renal transplantation.
OBJECTIVE
Wound infection in the setting of immunosuppressed state such as renal transplantation (RT) causes significant morbidity from sepsis, prolongs hospital stay and is expensive. Vacuum-assisted closure (VAC) therapy is a new technique of management of wound based on the principle of application of controlled negative pressure. The aim of this study was to assess the efficacy of VAC therapy in the management of wound infection following RT.


METHODS
This is a prospective study of a cohort of 180 consecutive RTs performed over a period of 4 years, where the data were retrieved from a prospectively maintained computerised database and case-notes.


RESULTS
9 of 180 (5%) patients developed wound infection following RT which led to cavitations and dehiscence with copious discharge, and refused to heal with conventional treatment. All 9 cases were treated with VAC therapy. The VAC system was removed after a median of 9 (range 3-30) days when discharge from the wound ceased. Four patients were discharged home with portable VAC device and managed on an outpatient basis, where the system was removed after a median 5.5 (range 3-7) days. The median hospital stay after initiation of VAC therapy was significantly shorter (5, range 2-12 days) than on conventional treatment prior to VAC therapy (11, range, 5-20 days) (p=0.003). Complete healing was achieved in all cases.


CONCLUSIONS
The use of VAC therapy is an effective and safe adjunct to conventional and established treatment modalities for the management of wound infection and dehiscence following RT. Key words: Renal transplantation, wound infection, vacuum-assisted closure therapy.
Shrestha
B M
BM
Sheffield Kidney Institute, Sheffield, UK. shresthabm@doctors.net.uk
Nathan
V C
VC
Delbridge
M C
MC
Parker
K
K
Throssell
D
D
McKane
W S
WS
Karim
M S
MS
Raftery
A T
AT
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D011446:Prospective Studies; D016896:Treatment Outcome; D014946:Wound Infection / Q000209:etiology / Q000628:therapy*