Indications for Vacuum-Assisted Wound Closure: When, Where and Why?

Vacuum-assisted wound closure relies on the application of negative pressure through an occlusive dressing. It acts by drawing the wound edges together, removing wound exudate and decreasing oedema, as well as by stimulating cell proliferation and differentiation, thus improving angiogenesis and promoting formation of granulation tissue. As this technique has become more popular over recent years, it is being applied for more and more indications. In orthopaedic surgery, it is used especially in wounds with a soft tissue defect, including exposed hardware; open fractures, especially of the lower extremities; for the fixation of skin grafts and flaps. The aim is to prevent breakdown or infection of high-risk surgical incisions; to accelerate closure of fasciotomies, and to improve the management of infected wounds. High-level evidence regarding the effectiveness of this technique and its superiority to other methods is scarce, and more studies are needed to clearly define the situations in which negative pressure wound therapy may be most useful.