Wild T, Otto F, Mojarrad L, Kellner M, Götzinger P
Medizinische Universität Wien, Klinische Abteilung für Allgemeinchirurgie, Wien.
Ther Umsch. 2007 Sep;64(9):495-503. doi: 10.1024/0040-5930.64.9.495.
Vacuum therapy is an efficient alternative to conservative wound care and creates new possibilities for the treatment of a variety of chronic and acute wounds. Already more than two thousand years ago vacuum treatment was applied in traditional Chinese medicine and also today vacuum therapy is used more and more frequently in daily clinical practice. The positive effects of the therapy are based on the stimulation of blood flow, formation of granulation tissue, angiogenesis, as well as cell proliferation, accelerated secondary wound closure and the removal of bacteria from the wound. As can be demonstrated based on a clinical picture of the open abdomen, vacuum therapy based on KCI's (Kinetic Concepts Inc) VA.C. system (Vacuum Assisted Closure) provides a possibility for not only accelerating the healing process, but also significantly lowering mortality. Since vacuum therapy in the form of the V.A.C. system represents a relatively expensive intervention, a comparison with conventional healing methods is demonstrated. Clinical studies with high evidence level show that both economic and clinical advantages of the vacuum therapy speak for its application. Savings with respect to the faster healing rates, the reduced dressing changes, as well as hospital stay and the care requirements, and the reduction of subsequent illnesses, compensate for the higher initial costs. Although many reports exist on treatment successes with the application of V.A.C. therapy, there are several cases for which vacuum therapy is contraindicated. In order to make sure that V.A.C. therapy is effective, a range of precautions and contraindications are described. The European Wound management Association (EWMA) just wrote a position paper on V.A.C. therapy. This is available at www.ewma.org.
负压疗法是保守伤口护理的一种有效替代方法，为治疗各种急慢性伤口创造了新的可能性。早在两千多年前，负压治疗就在传统中医中有所应用，如今在日常临床实践中也越来越频繁地使用。该疗法的积极作用基于对血流的刺激、肉芽组织的形成、血管生成以及细胞增殖，能加速伤口二期愈合并清除伤口细菌。从开放性腹部的临床情况可以证明，基于KCI公司（动力概念公司）的VA.C.系统（负压封闭引流）的负压疗法不仅为加速愈合过程提供了可能，还能显著降低死亡率。由于以V.A.C.系统形式存在的负压疗法是一种相对昂贵的干预措施，文中展示了与传统愈合方法的对比。高证据水平的临床研究表明，负压疗法在经济和临床方面的优势都支持其应用。更快的愈合速度、减少的换药次数、缩短的住院时间和护理需求以及后续疾病的减少所带来的节省，弥补了较高的初始成本。尽管有许多关于应用V.A.C.疗法取得治疗成功的报告，但也有一些情况是负压疗法的禁忌证。为确保V.A.C.疗法有效，文中描述了一系列预防措施和禁忌证。欧洲伤口管理协会（EWMA）刚刚撰写了一篇关于V.A.C.疗法的立场文件。可在www.ewma.org上获取。
