Abstract The use of subatmospheric pressure to pro-
mote wound healing has gradually found support in the
past few years. The vacuum-assisted closure system uses
a pump providing a continuous negative pressure of pref-
erably 125 mmHg, which is distributed over the wound
surface by an airtight covered foam. The exact mecha-
nisms of vacuum therapy are not yet understood, but
clinically soft tissue defects seem to heal faster when
subatmospheric pressure is applied. Our experience with
the first 100 patients with soft tissue defects of different
origin that were treated with vacuum therapy is present-
ed. In 29 patients, the wounds healed without further sur-
gical intervention, 53 patients underwent secondary
wound closure and 11 patients required more than one
procedure. Seven patients died due to their underlying
disease. Few complications were seen. Vacuum sealing
is a new therapeutic concept in wound healing which can
precede and sometimes replace surgical wound closure.
Key words Wound healing · Vacuum therapy
The treatment of large wounds with loss of soft tissue of-
ten consists of wound closure, using a split thickness
skin graft or by transposition or transplantation of tissue.
However, there may be circumstances in which wound
conditions or patient conditions do not permit a surgical
intervention. In these cases, secondary wound healing is
awaited and open wound treatment is often used.
An alternative treatment intended to promote second-
ary wound healing was introduced recently. This is the
concept of subatmospheric pressure, whereby the pres-
sure is equally distributed over the whole wound surface
by polyurethane foam. It is based on animal experiments
and subsequent clinical work by Argenta and Morykwas,
who found that by applying negative pressure to the
wound surface, local blood flow of the wound margins
increased by 400%, bacterial counts decreased signifi-
cantly, and formation of granulation tissue was en-
hanced. The best results were achieved, using a subatmo-
spheric pressure of 125 mmHg [1,6,8].
There have been other reports of successful treat-
ment using Argenta’s negative pressure technique
[2,9,10]. Fleischmann treated a large number of pa-
tients, using different materials but with the same prin-
Empirical data have strongly suggested a beneficial
effect of this therapy, and it seems useful to try to identi-
fy the different indications for its use. We will try to do
this, based on an experience of 100 patients with wounds
of different origin, treated with vacuum therapy between
December 1996 and August 1999.
Materials and methods
From December 1996 to August 1999, 100 patients were treated
with vacuum therapy. Five groups of patients were identified, ac-
cording to the type of wound they had (Fig. 1).
Group 1 consisted of 23 patients with a total of 26 stage IV
pressure sores, involving skin, subcutaneous tissue, muscle, and
bone. The mean age in this group was 46 years (range 17–77
years). Eighteen were wheelchair bound, following a spinal cord
injury, multiple sclerosis or repaired meningomyelocele. In five
patients, there was no neurological disorder but the pressure sore
was due to lengthy immobilization and poor physical condition.
The ulcers were located in the sacral, the ischial or the trochanter-
ic region, and in one case the heel. Most of the patients were in a
poor physical condition and nutritional state.
Group 2 consisted of 42 patients with a major postoperative
wound infection in the abdomen, groin, knee or ankle. The mean
age in this group was 62 years (range 20–89 years).
Group 3 consisted of 19 patients with a chest wall dehiscence
following cardiac surgery complicated by mediastinitis. The mean
age in this group was 67 years (range 46–85 years).
J.F.A. van der Werff (
) · R.A. Schasfoort · M.C. Obdeijn
M.Y. de Lange · J.P.A. Nicolai
Department of Plastic Surgery,
Academisch Ziekenhuis Groningen, Postbus 30.001,
9700 RB Groningen, The Netherlands
Tel.: +31-50-361-3531, Fax: +31-50-361-3043
Eur J Plast Surg (2000) 23:178–182 © Springer-Verlag 2000
M.Y. de Lange · R.A. Schasfoort · M.C. Obdeijn
J.F.A. van der Werff · J.P.A. Nicolai
Vacuum-assisted closure: indications and clinical experience
Received: 18 January 2000 / Accepted: 9 February 2000