Vacuum-assisted therapy for wound closure acceleration in second intention healing and prophylaxis of pathological scarring
Authors: V. V. Teplyi  , K. M. Grebchenko  
Published: January 2019

The aim — to evaluate the possibility to accelerate wound healing by second intention and prophylaxis of pathological scaring with vacuum‑assisted closure (VAC) therapy.Materials and methods. The 12 patients in control group were studied retrospectively. Twelve patients of the study group were evaluated prospectively during 2016 — 2018 years. The inclusion criteria were: age from 18 to 70 years, wound with granulation tissue, possibility to approximate wound’s margins mechanically even with the moderate tension, possibility to create negative pressure in the wound’s cavity. Control group’s patients were treated by the routine methods. Main group’s patients were treated with the use of original method of wound healing by second intention closure acceleration and prophylaxis of pathologic scaring. Planimetric study of wound and final scars were performed in all patients.Results and discussion. Initial linear dimensions and area of wound defect were not statistically different in control and study groups. In last one wound edge were somewhat brought together by sterile adhesive film. The drain with the side halls was introduced into the wound cavity. The film was covered by the transparent elastic plastic plate. Tightness of the construction and plate fixation were provided by additional layer of adhesive film. The drain was connected to the source of negative pressure. Wound revision was performed at the fifth day. In case when wound edges were not in contact, the same treatment was continued. To the second stage of treatment proceeded after complete approximation of the wound edges. Approximated edges were fixed by the same film with the perforations along the wound axis. The drain was set over the film along its perforations. It was fixed by additional layer of the film and connected to the source of negative pressure. Law pressure was maintained until fool fixation of wound edges. Comparison of the wound healing time demonstrated that it was statistically shorter in study group (26.7 ± 6.29 days vs 37.3 ± 78.33 days respectively, p = 0.0009). Planimetric study of the scars supported better cosmetic result of the treatment in study group.Conclusions. Law pressure inside the wound promotes progressive approximation of the edges with their subsequent fixation until the moment of sealing. This accelerated healing of wounds in patients of the main group compared with patients in the comparison group (26.7 ± 6.29 days versus 37.3 ± 7.33 days, respectively, p = 0.0009). Improved adaptation of wound edges without additional mechanical damage together with compensation by the vacuum forces that pull apart wound edges allowed to achieve wound healing in patients of main group with the formation of scars of a smaller width (12.0 ± 5.69 mm vs. 28.0 ± 10.95 mm, p = 0.0002) and the area (636.9 ± 536.41 mm2 versus 1150.9 ± 595.86 mm2, p = 0.0370) compared with the comparison group. In the main group normotrophic scars developed statistically significantly higher than in the comparison group (χ2 = 4.20, p = 0.04).