Background/Purpose: To present a case study of an individual using wound Vacuum Assisted Closure (VAC) to heal an extensive flank wound and answer the following PICO question: For a 50 to 65 year old male with a history of Crohns disease, is Vacuum Assisted Closure therapy superior to wet-to-dry dressings to close an open wound due to an abscess? Case Description: Mr. F is a 57 year old male with a 21-year history of Crohn's disease and surgical history of multiple surgical procedures for irrigation and drainage (I & D) of abscesses with no other significant past medical history. Mr. F reported to the Emergency Room on 10/25/12 with complaints of an open abscess to his left lower quadrant. From the emergency department, Mr. F was taken to the operating room for an I & D on 10/25/12, sent to the ICU for monitoring, returned to the OR on 10/27/12 for another I & D along with placement of a wound VAC, and was then admitted to the acute care department with a consult referral from the physician for gait evaluation and wound care to be performed by Inpatient Physical Therapy. Mr. F presented with an extensive open wound of the left flank that was treated by Physical Therapy using wound VAC therapy to promote wound closure. In an avoidable complication, two VAC sponges were left in the undermining areas of the wound bed from the original application of the wound VAC. These were found four days later and forcibly removed by Physical Therapy. Mr. F made an uneventful recovery from this point and was discharged home from the hospital with a portable wound VAC unit and orders to attend the outpatient Physical Therapy wound care clinic. Outcomes: Mr. F was able to decrease undermining from 10 cm to 6.5 cm in 16 days using the KCI wound VAC unit to promote closure. Further follow-up was lost due to the discharge of Mr. F to home with outpatient wound care clinic and the completion of this clinical rotation in which access to medical records was terminated. Discussion: While the Systematic Reviews find the results of wound VACs to be inconclusive and recommend further research, high level RCTs provide positive evidence to support the use of wound VAC therapy to decrease time of healing to full wound closure. Additionally, the complication of retained VAC sponges from this case study acts as further indication that standardized guidelines need to be established and recognized throughout disciplines in order to prevent the misuse of wound VAC therapy and improve patient care.
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Crohn's Disease, Wound VAC Therapy (vacuum assisted closure), Negative Pressure Wound Therapy, abcess, retained sponge/foam
Thomas, Leah. "For a 50 to 65 year old male with a history of Crohns disease, is Vacuum Assisted Closure therapy superior to wet-to-dry dressings to close an open wound due to an abscess?'." (2014). http://digitalrepository.unm.edu/dpt/39
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