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VAC Veraflo Cleanse Choice - positive outcomes in wounds with non-viable tissue. A case report.

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Introduction 

Wound healing involves a complex series of events. At any stage of this process healing can be interrupted. Delayed wound closure is a common problem for medical staff, which poses a significant social and financial burden. The most common wound healing impairments are haematoma, necrosis of the wound, infection, nutrition and perfusion to name a few. Gray D, Acton C, Chadwick P, et al. (2011).  Wound debridement is an essential part of wound care, of which there are many treatment modalities. Wounds may be surgically debrided in the initial phase but may also require ongoing debridement to continue optimisation of wound healing. In some instances surgical debridement is not an option. VAC Veraflo Cleanse Choice dressing is a relatively new dressing providing an innovative approach to wound cleansing, Kim PJ, Attinger CE, Crist BD, et al. (2015).VAC Veraflo Cleanse Choice in conjunction with VAC Veraflo Therapy can be used to facilitate removal of infectious materials including, slough, exudate and other wound bio burden. This process involves mechanical movement at the wound surface, combined with instillation of a topical solution delivered on a cyclical basis.  The dressing consists of three different layers of foams. A contact layer with larger punched holes and two foam layers, one thick and one thin to provide application options for wounds with varying depths.   Indications for use are subject to clinical assessment and maybe considered when surgical debridement is inappropriate or not possible due to patient condition.   The following will report a series of cases of different wound types where VAC Veraflo Cleanse Choice was used in conjunction with a sterile iso-osmotic wound irrigation solution with 0.02% polyhexanide and continuous negative pressure application. 

 

 Method

3 patients were selected based on an assessment of their wound. The patients chosen presented with different clinical indications.  

•  Partial Abdominal Wound Dehiscence in a patient with significant co-morbidities

•   Suspected deep tissue injury to buttock in a patient unsuitable for debridement in theatre 

• Diabetic foot ulcer (heel) post extensive surgical debridement by vascular team who developed post operative infection          

   

 The specific aims of this evaluation were to: 

 •  Assess the feasibility of using VAC Veraflo Cleanse Choice as a valid means of wound debridement. 


Results 

The use of the VAC Veraflo Cleanse Choice system resulted in the removal of slough and exudate from the wound bed, and initiated successful granulation tissue formation. The time taken to remove non viable tissue varied across the patient case load, depending on the complexity of each wound. This can be seen in the supporting images.  

 

 Discussion 

VAC Veraflo Cleanse Choice presents clinicians with an innovative additional means of managing such wounds when other treatment modalities are not a viable option. Consideration should be given to the type of instillation solution to be used, duration of treatment and acceptability of use to the patient. As with all products, contraindications to use must be adhered to.  The addition of the VAC Veraflo Cleanse Choice dressing has revolutionised the treatment of these complex wounds. The patients involved in the evaluation did not report any negative effects when cleanse choice therapy was commenced.  Following training provided staff did not report any issues with VAC Veraflo Cleanse Choice use and consultants were satisfied with the outcomes achieved.   

 

Conclusion

As with the introduction of any new system, both staff and patient opinion and training needs must be taken into consideration. Whilst the integration of VAC Veraflo Cleanse Choice is in the initial stages, results to date strongly support its application into clinical practice.   

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