Foot & Ankle

Incisional VAC comes of age?

It has become common practice in some centres to apply ‘incisional VAC’ dressings to potentially problematic wounds. Early work has suggested that this may improve healing rates and decrease post-operative infection levels in high-risk wounds. Total ankle arthroplasty is growing in popularity, and it seems that the indications are broadening endlessly. Complication rates are well documented and, given the extremity of the surgery, wound breakdown and infection are among the most serious. There are reports in the literature of wound breakdown rates after TAA affecting up to 40% of patients in some cohorts. This study from Winston-Salem,North Carolina (USA) is a single-surgeon series and reports the outcomes using the incisional negative pressure VAC dressings for six days post-operatively. The authors report a matched retrospective cohort study. Groups were matched for demographics and risk factors pertaining to wound healing on a 1:1 basis, thus there were 72 patients (36 in each group) included in this study. The results are remarkable, with the VAC-treated group having a reported complication rate of just 3%, compared with 24% in the control group.³ While the study suggests that negative pressure dressings can have a positive effect on wound healing in the setting of a tenuous soft-tissue envelope, it is important to put these findings into context and remember that, in this kind of historical change-of-practice study, this may not be the only relevant variable that has changed during the study period.