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Be cautious when using negative pressure wound therapy and anticoagulants

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KOHALA COAST, Hawaii — While vacuum-assisted closure can help manage soft tissue problems, surgeons should be aware of potential complications, according to an orthopedic trauma specialist from Minnesota.

During his presentation at Orthopedics Today Hawaii 2010, David C. Templeman, MD, noted that vacuum-assisted closure (VAC) is a negative pressure wound therapy that modulates the healing process in part by removing excess interstitial fluid and enhancing humoral mechanisms involved in healing.

“We all know it helps induce granulation tissue and helps [reduce] our healing time,” Templeman, a trauma co-chair for the meeting, said. “It probably helps reduce bacterial loads , but I have not overlooked the responsibility in terms of doing an IV, and it clearly has helped a lot people.”

During his presentation, Templeman cited a recent FDA alert that was issued regarding negative pressure wound devices. The alert was based on 83 cases in which six deaths and 77 injuries occurred after a wound VAC was directly applied over a vascular graft. In the cases, the sponge dressings became adherent and caused bleeding problems.

“You need to be aware of this because this will cause a fit for us. In the patients who are anticoagulated, when the dressing changes have become adherent, we really need to ensure that the people who are doing those dressing changes are confident in terms of doing them.”

He added, “The big problems or the big things to look at are if you are putting a wound VAC on patients who are on anticoagulation. Some of the worse ones in this seem to be on wounds that were in the groin area.”

Templeman also said that questions remain regarding VAC use including whether antibiotic beads need to be used with these systems. “There are still questions about the length of application and the size of the wound on which you can use them,” he added.

• Reference:

Levine WN. Imaging in instability. Presented at Orthopedics Today Hawaii 2010. Jan. 10-13, 2010. Kohala Coast, Hawaii.