Vacuum-assisted wound closure versus alginate for the treatment of deep perivascular wound infections in the groin after vascular surgery.
BACKGROUND
Vacuum-assisted wound closure (VAC) therapy may heal wounds faster than conventional dressings after surgical debridement of perivascular groin infections after vascular surgery.


METHODS
Patients with deep infected wounds (Szilagyi grade III) were surgically revised and left open for secondary healing, then randomized to either VAC or alginate (Sorbalgon) therapy, between February 2007 and November 2011. To test the hypothesis, it was calculated that 42 patients needed to be included (90% power, 5% level of significance). It was decided to perform an interim analysis after inclusion of 20 patients.


RESULTS
Among 66 patients undergoing groin revision, 20 patients were included in this study. Patients were randomized to VAC (n = 10) or alginate (n = 10). The two groups were comparable in patient and wound characteristics. Time to full skin epithelialization was significantly shorter in the VAC group (median, 57 days) compared with the alginate group (median, 104 days; P = .026). The number of positive wound cultures of bacteria and C-reactive protein values decreased equally in both groups between surgical revision and day 21. One femur amputation was performed in each group as a consequence of the groin infection, one patient died during the in-hospital stay in the alginate group, and none died in the VAC group.


CONCLUSIONS
VAC achieves faster healing than alginate therapy after wound debridement for deep perivascular wound infections in the groin after vascular surgery. This finding does not allow further inclusion of patients from an ethical point of view, and this study was, therefore, stopped prematurely.
Vascular Center, Malmö-Lund, Skåne University Hospital, Malmö, Sweden. Electronic address: christina.monsen@skane.se.
Christina
C
Monsen
Department of Care Science, Malmö University, Malmö, Sweden; The Swedish Institute of Health Sciences, Lund University, Lund, Sweden.
Christine
C
Wann-Hansson
Vascular Center, Malmö-Lund, Skåne University Hospital, Malmö, Sweden.
Catharina
C
Wictorsson
Vascular Center, Malmö-Lund, Skåne University Hospital, Malmö, Sweden.
Stefan
S
Acosta
D000368:Aged; D000369:Aged, 80 and over; D000464:Alginates / Q000009:adverse effects / Q000627:therapeutic use*; D000671:Amputation, Surgical; D001458:Bandages / Q000009:adverse effects; D002097:C-Reactive Protein / Q000378:metabolism; D016009:Chi-Square Distribution; D003646:Debridement; D057239:Early Termination of Clinical Trials; D005260:Female; D020723:Glucuronic Acid / Q000009:adverse effects / Q000627:therapeutic use; D006119:Groin / Q000098:blood supply*; D006603:Hexuronic Acids / Q000009:adverse effects / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects / Q000401:mortality; D011446:Prospective Studies; D062326:Re-Epithelialization; D012086:Reoperation; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D014945:Wound Healing
D000464:Alginates; D006603:Hexuronic Acids; D020723:Glucuronic Acid; D002097:C-Reactive Protein