title: Vacuum assisted wound closure in patients with lower extremity arterial disease. The experience from two tertiary referral-centres.
abstract: OBJECTIVE
  The purpose of this investigation was to analyze predictors for wound healing, amputation and mortality after vacuum assisted closure (VAC) therapy of wounds in the lower limb in patients with arterial disease.
  
  
  METHODS
  One hundred and twenty one wounds were treated and followed for 12 months at two vascular centres in Uppsala and Malmö, Sweden. VAC therapy was applied in the wound at a topical negative pressure of 125 mmHg.
  
  
  RESULTS
  Median age of the patients was 74 years and critical lower limb ischemia was present in 87% of the patients at admission. Intestinal flora was cultivated in 74% of the wounds. VAC associated bleeding occurred in four patients. Complete wound healing was achieved in 66%. Deep groin infections were associated with synthetic graft infection (P<0.001), treatment outside hospital (P<0.001), faster healing (P<0.01) and lower amputation rate (P<0.005). Diabetes mellitus (OR 2.7; [95% CI 1.2-6.2]) and foot wound (OR 3.0; [95% CI 1.2-7.4]) were independent predictors for amputation. The absence of complete wound healing was the strongest factor for both amputation (P<0.001) and death (P<0.001).
  
  
  CONCLUSIONS
  VAC therapy of complex wounds in the lower limbs in patients with vascular disease was associated with high healing rates. Non-healed wounds after VAC therapy were predictors for amputation and death.
authors.affiliation: Institution of Surgical Sciences, Uppsala University Hospital, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Nordmyr
authors.forename: S
authors.initials: S
authors.lastname: Svensson
authors.forename: M
authors.initials: M
authors.lastname: Björck
authors.forename: S
authors.initials: S
authors.lastname: Acosta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D012189:Retrospective Studies; D014945:Wound Healing; D055815:Young Adult