Introduction: Infections to musculoskeletal system has always been a matter of great worry to the orthopedic surgeon. Wound healing remains a challenging clinical problem to orthopedic surgeon and correct, efficient wound management remains essential in total. To overcome this complication a novel innovation in wound therapy, Negative pressure wound therapy (NPWT), also known as vacuum assisted closure (VAC) dressing, which was described initially by the Fleishmann in 1993. And was introduced in clinical practice by Argenta and Morykwas, became an important and effective tool for successful treatment of infection in complex wounds. Negative pressure wound therapy (NPWT) has been associated with low complication rate and better patient compliance by providing greater comfort as well as reducing time of hospitalization, use of antibiotics, and number of dressing changes.

Aim: The aim of this study was to evaluate the results and benefits brought by the topical application of Vacuum-assisted Closure (VAC) in patients with infected wounds of musculoskeletal system.

Methods: This prospective study was conducted in a tertiary care hospital of north India from January 2017 to December 2018. The VAC therapy was used in 52 patients having infected wound of the musculoskeletal system with male to female ratio of 1.73:1. All these wounds failed to be closed primarily or required partial thickness skin grafting (PTSG) or flap coverage. The results were presented in suitable tabular and descriptive form. The negative pressure therapy (NPWT) was applied to the infected wound after proper Wound wash and debridement, in continuous mode for an average length of treatment of 20.63 days with a negative pressure between 75 to 200 mmHg.

Results: Intermittent negative pressure was applied in all patients. The frequency of VAC dressing change was done every 4-5 days .the average number of VAC dressing used were 4.3 .the mean use of negative pressure therapy was 20.63 days. The decrease in wound size attained by VAC therapy ranged from 2.8 to 26.3cm2, with an average reduction of 12.13 cm2. All the patients showed a positive outcome with respect to wound healing and complete eradication of infection.

Conclusion: VAC has been a reliable method of treating a variety of different wounds. The dramatic result of the VAC therapy by increases the rate of granulation tissue formation and by lowering of the  bacterial counts to accelerate wound healing  thus significant reduction in hospital stay and the readmission with the result the burden to the both hospital and to patient has been remarkable especially in developing country with decreased inpatient capacity. The fear of the pain and discomfort to patient due to regular dressing has made the application of VAC for patient a sigh of relief.

1. Velnar T, Bailey T, Smrkolj V. The Wound Healing Process: an Overview of the Cellular and Molecular Mechanisms. The Journal of International Medical Research. 2009;37(5):1528–1542.
2. Bihariesingh V.J., Stolarczyk E.M., Karim R.B., van Kooten E.O. Plastic solutions for orthopaedic problems. Arch Orthop Trauma Surg. 2004;124(2):73–76.
3. Kramhøft M., Bødtker S., Carlsen A. Outcome of infected total knee arthroplasty. J Arthroplasty. 1994;9(6):617–621.
4. Clifford R.P. Artmed; Porto Alegre: 2002. Fraturasexpostas. Princípios AO do tratamento de fraturas; pp. 617–640
5. McCallon S.K., Knight C.A., Valiulus J.P., Cunningham M.W., McCulloch J.M., Farinas L.P. Vacuum-assisted closure versus saline-moistened gauze in the healing of postoperative diabetic foot wounds. Ostomy Wound Manag. 2000;46(8):28–32.
6. Fleischmann W, Strecker W, Bombelli M, Kinzl L. Vacuum sealing as treatment of soft tissue damage in open fractures. Unfallchirurg. 1993;96(9):488–492.
7. Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg. 1997;38(6):553–562
8. Hunter J.E., Teot L., Horch R., Banwell P.E. Evidence-based medicine: vacuum-assisted closure in wound care management. Int Wound J. 2007;4(3):256–269.
9. Vikatmaa P., Juutilainen V., Kuukasjärvi P., Malmivaara A. Negative pressure wound therapy: a systematic review of effectiveness and safety. Eur J Vasc Endovasc Surg. 2008;36(4):438–448.
10. Scherer S.S., Pietramaggiori G., Mathews J.C., Prsa M.J., Huang S., Orgill D.P. The mechanism of action of the vacuum-assisted closure device. PlastReconstr Surg. 2008;122(3):786–797.
11. Chen SZ, Li J, Li XY, Xu LS. Effects of vacuum-assisted closure on wound mic
12. Genecov DG, Schneider AM, Morykwas MJ, Parker D, White WL, Argenta LC. A controlled sub atmospheric pressure dressing increases the rate of skin graft donor site reepithelialisation. Ann Plast Surg. 1998;40:219–25.
13. Weed T, Ratliff C, Drake DB. Quantifying bacterial bio burden during negative pressure wound therapy: does the wound VAC enhance bacterial clearance? Ann Plast Surg. 2004;52:279–80.
14. Mullner T, Mrkonjic L, Kwasny O, et al. The use of negative pressure to promote the healing of tissue defects: a clinical trial using the vacuum sealing technique. Br J PlastSurg 1997; 50: 194-9
15. DeFranzo AJ, Argenta LC, Marks MW, et al. The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone. PlastReconstrSurg 2001 Oct; 108 (5): 1184-91
16. Armstrong DG, Lavery LA. Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet 2005;366:1704-10.
17. McCallon SK, Knight CA, Valiulus JP, Cunningham MW, McCulloch JM, Farinas LP. Vacuum-assisted closure versus saline-moistened gauze in the healing of postoperative diabetic foot wounds.Ostomy/Wound Management. 2000;46(8): 28–34.

18. Armstrong DG, Lavery LA, Abu-Rumman P, Espensen EH, Vazquez JR, Nixon BP, et al. Outcomes of subatmospheric pressure dressing therapy on wounds of the diabetic foot. Ostomy Wound Manage 2002;48:64-8.
19. Clare MP, Fitzgibbons TC, McMullen ST, Stice RC, Hayes DF, Henkel L. Experience with the vacuum assisted closure negative pressure technique in the treatment of non-healing diabetic and dysvascular wounds. Foot Ankle Int 2002;23:896-901.
20. Fleischmann W, Lang E, Klinzl L. Vacuum assisted wound closure after dermatofasciotomy of the lower extremity [in German]. Unfallchirurg 1996; 99 (4): 283-7
21. Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum- assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann PlastSurg 1997;38:553-62.

Dr Malik Naseer Ahmad