Skip to main content
. 2011 Sep 30;6(3):155–163. doi: 10.5114/wiitm.2011.24694

Table I.

Clinical data, indications and the course of VAC treatment

Patient characteristics at onset of treatment Patient 1, F, 26 years old1.

  1. Laparoscopic cholecystectomy, iatrogenic bile duct injury, laparotomy, cholecystoduodenostomy. Peritoneal drainage

  2. Relaparotomy due to anastomotic insufficiency and dilation of biliary-duodenal fistula. Partial resection of small intestine. Cholecysto-intestinal anastomosis. Peritoneal drainage

  3. Relaparotomy. Revision of cholecysto-intestinal anastomosis and subsequent anastomosis. Dressing of intestinal fistula. Peritoneal drainage

 Patient 2, M, 62 years old

  1. Partial sigmoidectomy due to perforation of inflammatory tumour of sigmoid colon with end-to-end anastomosis. Peritoneal drainage

  2. Relaparotomy. Eventration. Anastomotic insufficiency. Formation of colostomy. Peritoneal drainage

 Patient 3, M, 38 years old

  1. Stomach perforation. Iatrogenic large bowel injury (puncture lavage). Laparotomy. Stitching of abdomen and large bowel. Peritoneal drainage

  2. Relaparotomy. Small bowel necrosis (approx. 100 cm), resection of small bowel – Hartmann's procedure. Peritoneal drainage

  3. Relaparotomy. Small bowel fistulae. Partial resection of the distal small intestine. Another formation of the stoma. Peritoneal drainage
Indications for VAC therapy High-output biliary and intestinal (duodenal) fistula with two orifices at the wound site, complete dehiscence of the wound. Active biliary/intestinal fistula (1500-2000 ml) out of three sites of previous drains. Significant inflammatory and necrotic changes of the wound edges. General condition severe, septic shock symptoms, multi-organ insufficiency, mechanical ventilation, haemofiltration Eventration of vast areas of abdominal layers preventing their suturing. Conglomerate of intestinal loops (small intestine) with at least three active fistulae. Intestinal contents at the site of previous drain, outside the wound. Inflamed intestinal loops, increased adhesions, impossibility of loop identification. Total output of fistulae up to 3000 ml. Significant inflammatory and necrotic changes of the wound edges. Inactive single-barrel ileostomy. General condition severe, septic shock symptoms, multi-organ insufficiency, mechanical ventilation Eventration, active intestinal fistula, two orifices at the wound site, two orifices at the sites of previous drains, spontaneous fistula outside the wound, located at its inferior pole. Skin and soft tissue necrosis of stoma areas. Necrosis of the distal part of the bowel at the site of the stoma. Total fistula output ranging from 2000 to 2500 ml per day. Significant inflammatory changes of the skin at the wound edges, hypogastrium, groin, perineum (intestinal contents leakage). General condition severe. Short bowel syndrome. Cachexia. Septic shock. Systemic mycosis
0-7 days Dressing changed up to two times daily. Slight decrease in fistulae output (1400-1600 ml). Closure of one orifice outside the wound Dressing changed every 24-48 h. Decrease in fistulae output to approx. 2000-2500 ml/day. The necessity of using two VAC drains with Y-convector. Decrease of CRP and procalcitonin levels. Extubation on 6th day of VAC therapy Dressing changed initially every 24-48 h. Decrease in fistulae output < 2000 ml. General condition improved. Decrease of CRP level
8-14 days Dressing changed every 24-48 h. Gradual contraction of the wound. Fistula output ranging from 500 to 1500 ml/day. Closure of another orifice outside the wound. Extubation. Decrease of CRP and procalcitonin levels. Haemofiltration withdrawn Dressing changed every 48 h. Closure of the fistula orifice outside the wound. Contraction of the wound. Improvement in the general condition. Decreased fistula output < 2000 per day. Presence of intestinal contents in stoma. Initiation of the gradual closure of the wound with 0-2 skin sutures, two sutures at the superior and inferior wound poles with every dressing changed Dressing changed every 48 h. Closure of the fistula orifice outside the wound. Fistula output ranging from 1500 to 2000 ml. Gradual decrease of necrosis at the previous stoma site. Decrease of procalcitonin level. Gradual closure of the superior pole of the wound with single sutures. Significant inflammatory leakage at the inferior pole (detachment of the drape, VAC system impaired)
15-21 days Dressing changed every 48-72 h. Further contraction of the wound. Closure of fistula orifices outside the wound. Fistula output < 500 ml/day. Initiation of partial enteral nutrition. Motor rehabilitation Dressing changed every 48-72 h. Closure of the fistula orifice at the wound site. Single VAC drain. Fistula output 1000-1500 ml/day. Further closure of the wound with single sutures at dressing changes Dressing changed every 48-72 h. Closure of the fistula orifice outside the wound. Fistula output of 1000-1500 ml. Lack of necrotic changes at the previous stoma site, granulation tissue formation, traces of stoma output
22-28 days Dressing changed every 72 h. Reduction of the wound size. Output 200-400 ml/day. Partial enteral nutrition Termination of VAC therapy. Further wound dressing with stoma equipment. Fistula output 500 ml/day, stoma semi-formed output 500-1000 ml/ day. Partial enteral nutrition Dressing changed every 48-72 h. Fistula output 500-1000 ml/day. Traces of stoma output. Contraction of the wound
29-35 days Termination of VAC therapy. Dressing of a minor fistula of the inferior pole of the wound with stoma equipment. Full enteral nutrition Dressing changed every 72 h. Output < 500 ml. Partial enteral nutrition. Reduction of the wound size
Further surgical procedures At 6 months following the end of VAC treatment, reconstruction of the digestive tract continuity was performed. No complications occurred At 5 weeks following the end of VAC therapy, laparotomy and reconstruction of the digestive tract continuity were performed. No complications occurred At 3 weeks following the end of VAC therapy, laparotomy and resection of the distal part of the small intestine (approx. 40 cm) and right hemicolectomy with side to side ileo-transverse anastomosis were performed. No complications occurred
Equipment 21 VAC abdominal dressing sets 11 VAC abdominal dressing sets 19 VAC abdominal dressing sets