What is Vacuum-assisted Closure Therapy (VAC Therapy)?

Evaluation of Research
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Abstract
Vacuum-assisted closure therapy (VAC), which is closely linked with negative pressure wound therapy, is a non-invasive healing system that uses a localized and controlled negative pressure to stimulate wound healing. VAC was compared with conventional moist wound dressing, and it is preferred for its efficacy in treating diabetic foot ulcers. It is associated with accelerated wound healing times, reducing healing time, hospital costs, the risk of infection/ bacterial colonization, and the number of dressing changes. Negative pressure wound therapy used in isolation or together with other similar techniques increases wound healing rate. The literature supports using VAC to treat diabetic foot ulcers as it promotes wound healing when negative pressure is applied. 
Background
* PICOT: in patients with diabetic foot ulcers, does is negative pressure wound therapy using vacuum-assisted closure more effective than advanced moist wound therapy in treating the ulcers?
Vacuum-assisted closure (VAC) or Negative pressure wound therapy (NPWT) action on wound healing works by removing excess interstitial fluid, stimulating tissue proliferation, and maintaining a suitable environment of wounds in terms of humidity and temperature. The idea behind using negative pressure to create a suction force that drains surgical wounds to promote wound healing. Eliminating excess fluids and exudates removes the barriers to healing, while the therapy also favors cell growth to stimulate granulation tissue. NPWT used alone or in conjunction with other similar techniques increases wound healing rates.Article 1
VAC dressing is a therapy to promote wound healing, and the researchers focused on the effectiveness of NPWT using VAC on ulcer management. Comparing the effectiveness of VAC against conventional dressing, there were higher costs when using VAC, but shorter stay in hospital and faster healing (Abdelhafez, Asar & Abdelkader, 2015). There was also higher complete healing in the NPWT group at 96% compared to the conventional dressing group at 88% (Abdelhafez, Asar & Abdelkader, 2015).
The research focused on fifty patients who had chronic diabetic foot ulcers classified as grade1 under the University of Texas diabetic foot classification (Abdelhafez, Asar & Abdelkader, 2015). In the two groups, there were 25 patients placed in the NPWT group and 25 in the conventional moist wound dressings group. There were randomization and patients ranged from 12 to 75 years, and those with infected ulcers were excluded from the study. In the conventional moist wound dressings if there were no signs of healing the process was repeated during the course of treatment in 10 weeks. Evaluation of the effectiveness of the interventions was based on wound healing, the tissue formation, and the surface area of the ulcers. The research findings validate the literature that highlights NPWT is an effective therapeutic intervention that has been used in special, acute, and chronic wounds (Abdelhafez, Asar & Abdelkader, 2015). Since the researchers focused on chronic DFUs, the research is relevant to the PICOT and research to evaluate the effectiveness of VAC in treating ulcers that have developed over time.
Article 2
Sajid et al (2015) reported that negative pressure wound therapy (NPWT) using vacuum-assisted closure was more effective in treating diabetic foot ulcers when compared to Advanced Moist Wound Therapy (AMWT). AMWT was used in Group A of the patients and NPWT in Group B with each group having 139 patients. The efficacy of NPWT on treating diabetic foot ulcers and complete ulcer closure is supported by other studies that highlight in is a safe therapy where there are significantly lower complications when compared with the standard moist wound therapy.
In the randomized control trial, patients were randomly placed in Group A or Group B. The data was collected and analyzed using SPSS Version 17.0 (Sajid et al., 2015). The mean and standard deviation values were determined for age, gender, efficacy, and wound healing, while the Chi-square test compared the efficacy of the two interventions. The mean duration of diabetes was 15.65 ±4.86 in group A and 15.96 ±5.79 years in group B (Sajid et al., 2015).The researchers also addressed comorbidity such as ischemic heart disease, hypertension, and neuropathy, but there was no statistically significant difference in the comorbid condition.
Application of the NPWT wound therapy to aid wound healing was first used in the treatment of soft tissue injuries in association with an open fracture. Still now in wound care, NPWT is applied to improve wound healing. NPWT exerts its effect through the direct and indirect effects of negative pressure. These effects include stabilization of the wound environment, increased blood flow, and wound deformation.
Article 3
The article by Liu et al (2017) is a systematic review and meta-analy...