Argenta 1997 - VAC

Summary

This prospective case series introduced the novel concept of negative pressure wound therapy using a vacuum-assisted closure (VAC) device. It was the first clinical application in humans after initial animal studies.

300 patients with chronic, subacute or acute wounds not amenable to primary closure were included. Exclusion criteria were active malignancy, osteomyelitis, or exposed vessels/viscera.

The VAC device uses an open-cell foam placed in the wound connected to a vacuum pump providing subatmospheric pressure evenly across the wound. Three wound categories were described:

• Chronic (>1 week old): 175 patients, mainly pressure ulcers and diabetic/venous ulcers. 171 responded with decreased edema, granulation tissue and wound contraction.

• Subacute (12 hours - 7 days old): 94 patients, mainly dehisced wounds and wounds with exposed hardware/bone. 72% decreased in size allowing definitive closure.

• Acute (<12 hours old): 31 patients, mainly traumatic avulsions and contaminated wounds. 30 treated successfully with VAC ± grafts/flaps.

Complications were rare - 2 late infections and 1 enteric fistula. No control group was used.

VAC removes edema, increases blood flow, and stimulates granulation tissue and wound contraction. It revolutionized wound care across specialties. Limitations of this early study were lack of controls and heterogeneity of groups/treatment.

This landmark paper pioneered VAC therapy which is now standard of care for difficult wounds. It has over 4000 citations and launched major research into wound healing mechanisms and applications of negative pressure therapy.