[Use of vacuum-assisted closure in the topical treatment of surgical site infections].
OBJECTIVE
This study was designed to evaluate the results of vacuum-assisted closure in the topical treatment of surgical site infections.


METHODS
Vacuum therapy was performed in 17 patients (10 males, 7 females; mean age 60 + or - 20 years) using the VAC system (Vacuum-Assisted Closure, Kinetic Concept Inc) for the treatment of surgical site infections. Infective wounds were in the hip (n=6), crus (n=5), knee (n=3), sacrum (n=2), and hand (n=1). The causative organism for infections was gram-positive bacteria in 15 patients (88.2%), and six patients (35.3%) had nosocomial infections. The wounds were treated with a negative pressure of 100-125 mmHg applied continuously for the first two days, and then intermittently for the following days. The mean follow-up period was 11 + or - 6 months.


RESULTS
The mean duration of vacuum therapy was 16 + or - 4 days and the mean length of hospitalization was 31 + or - 19 days. The patients underwent a mean number of three surgical procedures (range 1 to 6) before vacuum therapy. The mean amount of discharge from the wound was 500 + or - 150 ml. Tissue edema and discharge problems were resolved in all the wounds and a hygienic and dry-looking surgical site was attained. In 11 patients (64.7%), clinical and bacteriologic eradication of infections was achieved at the surgical site through antibiotic use and vacuum therapy. Six patients with nosocomial infections continued to receive antibiotic treatment following resolution of surgical site problems. The mean wound area showed a significant reduction from 36 + or - 14 cm(2) to 11 + or - 10 cm(2) following vacuum therapy (p<0.05). Only two patients (11.8%) required further surgical interventions for the closure of wound site. Two patients (11.8%) complained of pain associated with vacuum application.


CONCLUSIONS
Besides its topical advantages in the care of infected wounds, vacuum-assisted closure provides a more rapid and comfortable treatment opportunity, representing a reliable alternative to conventional wound care methods.
Kiliç
Ayhan
A
Department of Orthopedics and Traumatology, Taksim Training and Research Hospital, Istanbul, Turkey. kilicayhan@yahoo.com
Ozkaya
Ufuk
U
Sökücü
Sami
S
Basilgan
Seçkin
S
Kabukçuoğlu
Yavuz
Y
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001623:Betamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019534:Shoulder Impingement Syndrome / Q000601:surgery*; D013530:Surgical Wound Infection / Q000188:drug therapy*; D016896:Treatment Outcome; D014618:Vacuum
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D001623:Betamethasone; D002045:Bupivacaine