CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 2, March/April 2022 44 AFRICA Cardiovascular Topics The effectiveness of vacuum-assisted closure therapy in patients with infected venous leg ulcers Esra Ertürk Tekin, Mehmet Ali Yeşiltaş, Ayhan Uysal, İsmail Haberal Abstract Aim: In this study, we aimed to investigate the effect of vacuum-assisted closure therapy on venous stasis wound healing in patients with chronic venous leg ulcers. Methods: Vacuum-assisted closure therapy was applied on a total of 14 venous leg ulcers. All patients had post-thrombotic syndrome. Quantitative wound culture samples were obtained before the procedure and local wound assessments were performed. The primary outcome measures included wound healing as assessed by a local wound examination during each dressing change and the rate and velocity of ulcer reduction. Wound healing was defined as the complete closure of the ulcer, while rapid wound healing was defined as a ≥ 30% reduction in the ulcer size by week four. Results: No surgical debridement or surgical corrective procedure was applied in any patient. The mean length of hospital stay was 32.3 days. The mean number of vacuumassisted closure therapies for each case was 17.8 and the mean time to dressing change was 72.3 hours. Multidrugresistant Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were detected in three and four patients, respectively. Wound culture results became negative after a mean duration of vacuum-assisted closure therapy of 12.1 days. None of the patients needed antibiotic therapy until the procedure was completed. Compared to baseline, the mean ulcer reduction rates were 46.4% for the first six applications and 72.8% for the subsequent applications. Conclusion: Our study results suggest that vacuum-assisted closure therapy promotes rapid wound healing in patients with severe post-thrombotic syndrome with venous stasis leg ulcers, and reduces the need for antibiotics by reducing the biological burden. Keywords: vacuum-assisted closure therapy, venous ulcer, postthrombotic syndrome, wound infection, rapid wound healing. Submitted 7/12/20; accepted 30/6/21 Published online 26/7/21 Cardiovasc J Afr 2022; 33: 44–50 www.cvja.co.za DOI: 10.5830/CVJA-2021-034 The primary aims of wound healing are to restore the tissue architecture and integrity of the skin, achieve aesthetically favourable and sustainable results, relieve pain, improve patient comfort and quality of life, and prevent undesirable complications in a cost-effective manner.1 Chronic leg ulcers affect nearly 1% of the adult population.2 The prevalence of active leg ulcers has been estimated to be 15%.3 Venous disease accounts for 80% of all chronic leg ulcers.1 Venous hypertension has been proposed to be the main underlying pathophysiological mechanism of reflux and/ or obstruction of the venous system.1 Standard treatment includes surgical debridement, wound dressing with topical antimicrobials, compression therapy, pharmacological treatment and corrective procedures. Venous ulcers are the most common ulcers of the lower limbs however, the rate of complete healing is very low despite the application of standard treatment.4 Post-thrombotic syndrome (PTS), an important chronic consequence of deep-vein thrombosis (DVT), is an important condition for which patients frequently seek medical advice. PTS occurs in 20 to 50% of patients with DVT. PTS may present with clinical manifestations ranging from mild clinical symptoms to more severe manifestations, such as chronic leg pain, persistent oedema, and leg ulcers that limit activity and the ability to work.5 In five to 10% of patients, DVT will progress to severe PTS, which can include venous leg ulcers. A multidisciplinary approach should be used for venous ulcer management, which includes compression therapy, skin care and topical dressings. When conservative therapy fails, surgical or endovascular procedures may be recommended to treat large reflux vessels in selected patients. However, ulcers may be resistant to all treatment and frequently recur. Chronic wounds never become sterile and are mostly colonised with micro-organisms of the normal flora of intact skin. Chronic wounds are commonplace for bacteria and these bacteria do not always cause infections per se. The level of bacterial burden can be described as one of the following four conditions: (1) contamination, (2) colonisation, (3) critical colonisation, and (4) infection.6 Department of Cardiovascular Surgery, Mersin City Training and Research Hospital, Mersin, Turkey Esra Ertürk Tekin, MD, dresraer@yahoo.com Department of Cardiovascular Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey Mehmet Ali Yeşiltaş, MD Cardiovascular Surgery Clinic, Firat University Medical Faculty, Elazığ, Turkey Ayhan Uysal, MD Department of Cardiovascular Surgery, Istanbul University, Cerrahpasa Institute of Cardiology, Istanbul, Turkey İsmail Haberal, MD
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