“NEGATIVE PRESSURE, POSITIVE OUTCOMES: EVALUATING THE EFFICACY OF VACUUM-ASSISTED CLOSURE (VAC) THERAPY IN THE MANAGEMENT OF COMPLEX WOUNDS”
Main Article Content
Keywords
Vacuum-Assisted Closure, Negative Pressure Wound Therapy, complex wounds, wound healing, infection control, exudate management, chronic ulcers, surgical site infection, cost-effectiveness, evidence-based practice.
Abstract
Vacuum-Assisted Closure (VAC) therapy, also referred to as Negative Pressure Wound Therapy (NPWT), has emerged as a pivotal innovation in the management of complex wounds, offering an alternative to conventional dressing methods. The principle of VAC therapy involves the application of controlled sub-atmospheric pressure to the wound bed, promoting microdeformation, enhancing angiogenesis, reducing edema, and facilitating effective exudate management (Banwell & Téot, 2003). Over the past two decades, a growing body of clinical evidence has highlighted its efficacy in accelerating wound healing rates, reducing bacterial load, and improving patient comfort and overall outcomes (Argenta & Morykwas, 1997).
Studies demonstrate that VAC therapy can significantly shorten healing time in acute and chronic wounds, reduce surgical site infections, and decrease hospital stay duration, thereby contributing to improved cost-effectiveness in wound care (Blume et al., 2008; Vuerstaek et al., 2006). Its versatility across diverse wound etiologies—including traumatic injuries, diabetic foot ulcers, pressure sores, and post-surgical wounds—has reinforced its role in evidence-based clinical practice. However, limitations such as cost, contraindications, and potential adverse events necessitate careful patient selection and standardized protocol adherence to optimize outcomes.
This review synthesizes current evidence on the mechanisms, indications, comparative effectiveness, clinical outcomes, and future directions of VAC therapy, aiming to provide clinicians and researchers with a comprehensive understanding of its therapeutic potential and limitations in the context of complex wound management.
References
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2. Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W (1997). Vacuum-assisted closure: Animal studies and basic foundation. Annals of Plastic Surgery, 38(6):553–562.
3. Banwell P, Téot L (2003). Topical negative pressure (TNP): The evolution of a novel wound therapy. Journal of Wound Care, 12(1):22–28.
4. Orgill DP, Bayer LR (2013). Negative pressure wound therapy: Past, present and future. International Wound Journal, 10(S1):15–19.
5. Schintler MV (2012). Negative pressure therapy: Theory and practice. Ostomy/Wound Management, 58(1):44–55.
6. Mouës CM, Vos MC, van den Bemd GJ, Stijnen T, Hovius SER (2004). Bacterial load in relation to VAC therapy: Prospective randomized trial. Wound Repair and Regeneration, 12(1):11–17.
7. Blume PA, Walters J, Payne W, Ayala J, Lantis J (2008). NPWT vs advanced moist therapy for diabetic foot ulcers: RCT. Diabetes Care, 31(4):631–636.
8. Vuerstaek JD, Vainas T, Wuite J, Nelemans P, Neumann MH, Veraart JC (2006). VAC vs modern dressings for chronic leg ulcers: RCT. Journal of Vascular Surgery, 44(5):1029–1037.
9. Apelqvist J, Armstrong DG, Lavery LA, Boulton AJM (2008). VAC therapy for diabetic foot ulcers: Multicentre RCT. The Lancet, 366(9498):1704–1710.
10. Karlakki S, Brem M, Giannini S, Khanduja V, Stannard J, Martin R (2016). Incisional NPWT in orthopaedics: Evidence and recommendations. Bone & Joint Research, 5(8):328–337.
11. Lindholm C, Searle R (2016). Wound management for the 21st century. International Wound Journal, 13(S2):5–15.
12. Frykberg RG, Banks J (2015). Challenges in the treatment of chronic wounds. Advances in Wound Care, 4(9):560–582.
13. NICE (2019). Negative pressure wound therapy for the open abdomen. Medical Technologies Guidance.
14. Kim PJ, Attinger CE, Steinberg JS, et al. (2013). NPWT with instillation: International consensus update. International Wound Journal, 12(6):660–674.
15. Cowan LJ, Stechmiller JK, Phillips P, Yang Q, Schultz G (2012). Portable NPWT in home care: Clinical and economic impact. Wounds, 24(1):10–17.
16. Kairinos N, Solomons M, Hudson DA (2014). Negative pressure wound therapy I: The paradox. Plastic and Reconstructive Surgery, 133(3):589–600.
17. Weinfeld AB, Kelley P, Yuksel E, et al. (2005). Complications associated with NPWT. Annals of Plastic Surgery, 54(1):55–61.
18. Saxena V, Hwang CW, Huang S, Eichbaum Q, Ingber D, Orgill DP (2004). Microdeformation and cell proliferation under VAC. Plastic and Reconstructive Surgery, 114(5):1086–1096.
19. Armstrong DG, Lavery LA (2005). Negative pressure wound therapy after partial foot amputation: RCT. The Lancet, 366(9498):1704–1710.
20. Stannard JP, Volgas DA, McGwin G Jr, et al. (2012). Prophylactic NPWT on high-risk wounds: RCT. Journal of Orthopaedic Trauma, 26(1):37–42.
21. Stannard JP, Robinson JT, Anderson ER, McGwin G Jr, Volgas DA (2006). NPWT to prevent hematoma/infection in high-risk wounds. The Journal of Trauma, 60(6):1301–1306.
22. Willy C, Agarwal A, Andersen CA, et al. (2017). Closed incision negative pressure therapy: International consensus. International Wound Journal, 14(2):385–398.
23. Hyldig N, Birke-Sorensen H, Kruse M, et al. (2016). Prophylactic incisional NPWT after caesarean: Systematic review. BJOG, 123(4):538–545.
24. Hyldig N, Vinter CA, Kruse M, et al. (2019). Prophylactic incisional NPWT after caesarean in obese women: RCT. JAMA, 321(6):575–586.
25. Webster J, Liu Z, Norman G, et al. (2019). Incisional NPWT for closed surgical wounds: Cochrane Review. Cochrane Database of Systematic Reviews, Issue 3:CD009261.
26. Dumville JC, Owens GL, Crosbie EJ, Peinemann F, Liu Z (2015). NPWT for surgical wounds healing by primary closure. Cochrane Database of Systematic Reviews, CD009261.
27. Liu S, He CZ, Cai YT, et al. (2017). NPWT vs conventional care for diabetic foot ulcers: Meta-analysis. Journal of Foot and Ankle Surgery, 56(5):957–962.
28. Gabriel A, Wong WK, et al. (2008). Outcomes of VAC in complex patients. International Wound Journal, 5(2):225–234.
29. Atkins BZ, Wooten MK, Kistler J, Hurley K, Wolfe WG, Jones DR (2009). Prophylactic NPWT after cardiac surgery. Annals of Thoracic Surgery, 88(2):552–558.
30. Conde-Green A, Chung TL, Holton LH, et al. (2013). Incisional NPWT for high-risk closures. Aesthetic Surgery Journal, 33(3):353–367.
31. Sahebally SM, McKevitt K, Stephens I, et al. (2018). Prophylactic NPWT on closed laparotomy incisions: Meta-analysis. World Journal of Surgery, 42(7):1927–1938.
32. Strugala V, Martin R (2017). Meta-analysis of closed incision NPWT vs standard care. International Wound Journal, 14(2):255–268.
33. Willy C, Müller-Seubert W, et al. (2019). Evidence for ciNPWT in orthopaedics. Injury, 50(S1):S19–S25.
34. Gomoll AH, Lin A, Harris MB (2006). VAC after high-energy trauma. Journal of Orthopaedic Trauma, 20(10):683–689.
35. Wilkes RP, McNulty AK, Feeley TD (2009). Mechanisms of action in NPWT. International Wound Journal, 6(S1):2–10.
36. Fleischmann W, Lang E, Kinzl L (1993). VAC in open fractures. Der Unfallchirurg, 96(9):488–492.
37. Mirasol R, Chen C, Adams S (2011). NPWT in pressure ulcer management. Advances in Skin & Wound Care, 24(9):405–412.
38. Li Z, Yu A (2014). NPWT for skin graft fixation: Meta-analysis. International Wound Journal, 11(5):590–597.
39. Schilder A, Ghanem AM, Hettiaratchy S (2010). NPWT in burns. Burns, 36(5):663–668.
40. Gregor S, Maegele M, Sauerland S, et al. (2008). Topical negative pressure for acute and chronic wounds: Systematic review. European Journal of Trauma and Emergency Surgery, 34(6):527–544.
41. Argenta LC, Morykwas MJ, Marks M, DeFranzo AJ, Molnar JA, David LR (2006). NPWT for soft-tissue defects. Plastic and Reconstructive Surgery, 117(7 Suppl):127S–142S.
42. De Leon JM, Driver VR, Fylling CP, Carter MJ, Anderson C, Wilson J (2011). NPWT in diabetic foot management: Real-world outcomes. Ostomy/Wound Management, 57(4):32–44.
43. Reddix RN, Tyler HK, Krapohl GL, et al. (2009). NPWT for fasciotomy wounds. Journal of Surgical Orthopaedic Advances, 18(4):199–202.
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Oct 08, 2025
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Dr Vaseem Akram Vadhooth, Dr Krishnaprasad K, Dr Prakash Dave, Dr P N Sreeramulu, Dr Shashirekha C A, & Dr Ravikiran HR. (2025). “NEGATIVE PRESSURE, POSITIVE OUTCOMES: EVALUATING THE EFFICACY OF VACUUM-ASSISTED CLOSURE (VAC) THERAPY IN THE MANAGEMENT OF COMPLEX WOUNDS”. Journal of Population Therapeutics and Clinical Pharmacology, 32(9), 113-124. https://doi.org/10.53555/9jj3cv51
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Author Biographies
Dr Vaseem Akram Vadhooth
Junior Resident, Department of General Surgery, Sri devaraj urs academy of higher education and research
Dr Krishnaprasad K
Professor & HOU, Department of General Surgery, Sri devaraj urs academy of higher education and research
Dr Prakash Dave
Professor & HOD, Department of General Surgery, Sri devaraj urs academy of higher education and research
Dr P N Sreeramulu
Professor & HOU, Department of General Surgery, Sri devaraj urs academy of higher education and research
Dr Shashirekha C A
Professor & HOU, Department of General Surgery, Sri devaraj urs academy of higher education and research.
Dr Ravikiran HR
Associate Professor, Department of General Surgery, Sri devaraj urs academy of higher education and research
How to Cite
Dr Vaseem Akram Vadhooth, Dr Krishnaprasad K, Dr Prakash Dave, Dr P N Sreeramulu, Dr Shashirekha C A, & Dr Ravikiran HR. (2025). “NEGATIVE PRESSURE, POSITIVE OUTCOMES: EVALUATING THE EFFICACY OF VACUUM-ASSISTED CLOSURE (VAC) THERAPY IN THE MANAGEMENT OF COMPLEX WOUNDS”. Journal of Population Therapeutics and Clinical Pharmacology, 32(9), 113-124. https://doi.org/10.53555/9jj3cv51