Vacuum-assisted closure (VAC) is a technique that reduces air pressure around a wound to promote repair. It is also known as negative pressure wound therapy.
During VAC treatment, a clinician places a foam dressing over an open wound, then a vacuum pump generates negative pressure in the area. In other words, the pressure at the wound site is lowered relative to atmospheric pressure, which helps draw the wound edges inward.
Most clinical research on humans and animals has shown that VAC therapy is as effective as or superior to traditional wound-closure methods. VAC can support healing by decreasing swelling, encouraging new tissue formation, and reducing the risk of infection.
In this piece, we’ll explore how VAC supports wound healing, outline the advantages of VAC therapy, and answer frequent questions people have about this approach.
Who might benefit from a wound VAC?
VAC became a more common wound-care option through the 1990s and 2000s. This approach can be appropriate for people with several conditions, including the following:
Burn injuries
A retrospective review assessed VAC’s role in children with burn injuries or soft-tissue trauma.
Investigators observed a correlation between third-degree burn size and the number of VAC applications. They determined VAC could be a safe, effective choice that does not produce excessive discomfort in pediatric patients.
Cesarean delivery (C-section)
VAC may lower the risk of infection after cesarean birth.
A review of studies examined VAC in women with obesity who had a higher likelihood of wound complications. Overall, reviewers found VAC appeared to reduce infections and related complications.
Traumatic and postoperative wounds
VAC may be helpful for healing traumatic injuries and surgical wounds.
One review concluded VAC has the potential to reduce postoperative infections and might be more cost-effective than conventional care when hospital expenses are considered.
Pressure ulcers
Pressure ulcers are areas of damaged skin caused by prolonged pressure. VAC can be an appropriate option in certain cases.
An individual study described using VAC to treat a patient’s ulcer, where the ulcer healed in six weeks at about half the cost of reconstructive surgery.
Wound types not appropriate for VAC
VAC suits a broad array of wounds, but some wounds are not appropriate for negative-pressure therapy. These include:
- wounds close to joints that may reopen with movement
- areas containing cancerous tissue
- actively infected wounds
- exposed organs or major blood vessels
- very fragile skin
- regions with poor circulation
How VAC therapy functions
A VAC system consists of a vacuum pump, a specialized dressing, tubing, and a canister to collect wound fluids.
A clinician first places a layer of foam dressing into the wound and covers it with an adhesive film. The film contains a port through which tubing connects to the vacuum pump.
Once attached, the vacuum pump evacuates fluids and contaminants from the wound while helping to approximate the wound edges.
A person receiving VAC typically wears the device nearly 24 hours a day during the healing period. The commonly used negative pressure level is about 125 mm Hg, often applied in cycles such as 5 minutes on and 2 minutes off.
Is VAC therapy painful?
When VAC begins you may notice a sensation of pulling or stretching around the wound. VAC should not be painful; significant pain may signal a problem.
Many patients feel discomfort when dressings are changed. In some situations, a clinician may give pain medication 30–60 minutes prior to a dressing change.
Benefits of wound VAC
VAC can be a cost-saving and effective option for treating various wound types. Potential advantages include:
- reduced swelling and inflammation
- lowered risk of bacterial contamination
- improved blood flow to the wound
- less overall pain
- fewer dressing changes compared with some other methods
- gentle approximation of wound edges
Possible complications of VAC therapy
VAC therapy is usually safe, though complications can occur. One study reported two cases of sepsis and hemorrhage following VAC for burns.
Other potential issues include bleeding, wound infection, and failure of the wound to heal, which might necessitate more invasive interventions.
Some patients may develop an enteric fistula, where the intestinal tract abnormally connects to the skin.
Maceration of surrounding skin — softening and breakdown caused by moisture — is another possible complication.
Cost considerations
A retrospective analysis of VAC treatment costs at a major medical center estimated an average daily cost of about $111.18 for VAC therapy.
Most insurance plans and Medicare will cover at least part of VAC therapy costs.
Where VAC therapy is provided
VAC therapy can be delivered in a clinician’s office or in a healthcare facility.
In some cases, depending on wound size and location, VAC can be continued at home. Your surgeon will advise whether at-home therapy is appropriate for you.
How long VAC therapy lasts
The duration of VAC therapy varies based on the wound’s size and location. Your doctor can provide an estimate of how long you’ll require negative-pressure treatment.
Managing life with a wound VAC
Having a wound VAC can affect daily routines, but knowing what activities are allowed can make treatment easier to manage.
Can you shower with a wound VAC?
You can usually shower by briefly disconnecting the VAC device, though the system should not be left disconnected for more than about 2 hours a day.
Bathing in a tub is not recommended with a wound VAC, since soaking can expose the wound to bacteria.
How often are VAC dressings changed?
VAC dressings are typically changed two to three times per week. If the wound becomes infected, dressings may need more frequent changes.
Who changes the VAC dressing?
Most often a healthcare professional performs dressing changes. In certain circumstances, a family member or caregiver can be trained to change the dressing safely.
When to stop using a wound VAC
Although uncommon, VAC can cause bleeding, infection, or other serious adverse effects.
If you experience any of the following signs, contact your doctor promptly:
- fever above 102°F (39°C)
- bleeding from the wound
- skin rash around the wound
- dizziness
- nausea or vomiting
- confusion
- sore throat
- headache
- diarrhea
Summary
VAC therapy applies negative pressure to help close wounds and accelerate healing. It is used for many wound types, including burns, C-section incisions, and traumatic or surgical wounds.
No special preparation is usually required before starting VAC therapy.
If you’re receiving VAC treatment, discuss any specific concerns with your healthcare provider about your wound’s healing.
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