title: Vacuum-assisted closure versus closure without vacuum assistance for preventing surgical site infections and infections of chronic wounds: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  We sought to examine whether vacuum-assisted closure (VAC) is associated with fewer surgical site infections (SSIs) or infections of chronic wounds than other management procedures for surgical wounds.
  
  
  METHODS
  The PubMed and Scopus databases were searched systematically. Randomized controlled trials (RCTs) comparing the development of SSIs or infections of chronic wounds between patients treated with VAC for acute or chronic wounds and those whose wounds were treated without VAC were considered eligible for inclusion in the study.
  
  
  RESULTS
  Eight RCTs met the inclusion criteria for the study. Four of the studies included chronic or diabetic lower extremity wounds and four included fractures. In three of four studies reporting on fractures, the wounds were not closed post-operatively, whereas in one study primary closure of the wound was performed. With regard to wounds left open after the stabilization of fractures, patients whose wounds were treated with VAC developed fewer SSIs than those whose wounds were treated without VAC ([367 patients (196 with VAC; 171 without VAC) relative risk [RR], 0.47; 95% CI 0.28-0.81]). On the contrary, no difference in the development of SSIs occurred among patients with chronic or diabetic lower-extremity wounds treated with VAC and those whose wounds were treated without VAC ([638 patients (320 with VAC; 318 without VAC) RR 1.67; 95% CI: 0.71-3.94]).
  
  
  CONCLUSIONS
  The available evidence suggests that the development of infections in wounds treated with VAC depends on the type of wound being treated.
authors.affiliation: 1 Alfa Institute of Biomedical Sciences , Athens, Greece .
authors.forename: Giannoula S
authors.initials: GS
authors.lastname: Tansarli
authors.forename: Konstantinos Z
authors.initials: KZ
authors.lastname: Vardakas
authors.forename: Constantinos
authors.initials: C
authors.lastname: Stratoulias
authors.forename: George
authors.initials: G
authors.lastname: Peppas
authors.forename: Anastasios
authors.initials: A
authors.lastname: Kapaskelis
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Falagas
mesh_terms: D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014618:Vacuum; D058106:Wound Closure Techniques