Benefits of VAC Therapy

Benefits of VAC Therapy:Overview

Executive Summary

Negative Pressure Wound Therapy, V.A.C. Therapy has been

selected as the treatment of choice for more than 3,000,000
people worldwide
Recent studies have reported on the beneficial use of
NPWT/ROCF in temporizing combat wounds in preparation for
delayed primary closure. Adjunctive use of the therapy has
been shown to decrease time to closure, reduce amputations,
reduce infection, and decrease labor required for dressing
changes
Literature shows VAC Therapy may provide savings in trauma
wounds of $31,842 (for Abdominal Compartment Syndrome
patients) & savings of $33,040 (Limb Salvage)
This can account for an overall savings of $1.2M just for Limb
Salvage wounds

V.A.C. Therapy System

Overview
KCI's proprietary V.A.C. Therapy System has revolutionized the way
in which caregivers treat the most serious, complex wounds. V.A.C.
Therapy utilizes an open-cell polymer foam dressing that is conformed
to the wound bed. When sealed and placed under negative (vacuum)
pressure, the system creates a unique wound healing environment
that has been shown to promote the wound healing process, reduce
edema, prepare the wound bed for closure, promote the formation of
granulation tissue and remove infectious materials.
History
In 1996, KCI introduced this innovative approach to the treatment of
serious, complex wounds through the use of sub-atmospheric or
negative pressure. Known today as negative pressure wound
therapy (NPWT), KCIs proprietary Vacuum Assisted Closure, or
V.A.C. Therapy System has revolutionized the advanced wound care
market and remains the most clinically proven alternative for the
treatment of complex, hard-to-heal wounds.

http://www.kci1.com/KCI1/vactherapysystemfactsheet

V.A.C. Therapy

Since its introduction, V.A.C. Therapy has changed the way wounds
are healed. With more published clinical evidence than any other form
of Negative Pressure Wound Therapy, V.A.C. Therapy has been
selected as the treatment of choice for more than 3,000,000 people
worldwide.

V.A.C. Therapy promotes wound healing through Negative Pressure

Wound Therapy (NPWT). By delivering negative pressure (a vacuum)
at the wound site through a patented dressing, this helps draw wound
edges together, remove infectious materials and actively promote
granulation at the cellular level.

http://www.kci1.com/cs/Satellite?c=Page&childpagename=KCI1%2FKCILayout&cid=1229538260417&p=1229538260417&packedargs=locale%3Den_
US&pagename=KCI1Wrapper

V.A.C. Therapy Clinical Data

One of the most extensive bodies of evidence in Negative Pressure Wound
Therapy and Advanced Wound Care

For more than 10 years, V.A.C. Therapy, also known as NPWT (Negative
pressure Wound Therapy), along with V.A.C. GranuFoam Dressings has set
the standard for wound healing. This body of evidence includes:

The vast majority of published data related to NPWT products are based on the
V.A.C. Therapy System with V.A.C. GranuFoam Dressings. The unique open
cell, reticulated structure of the V.A.C. GranuFoam Dressings not only
differentiates the V.A.C. Therapy System from all other NPWT devices, the
proprietary foam dressing under negative pressure creates an environment that
promotes wound healing.

http://www.kci1.com/KCI1/vactherapyclinicalevidence

Use of Vacuum-Assisted Closure NPWT in Combat Related Injuries

Despite advances in surgical techniques and medical technology, managing

combat-related injuries remains challenging both within and outside the
war theater

Military studies reported the use of NPWT/ROCF to treat contaminated soft

tissue injuries, open fractures, open joints, traumatic amputations,
extremity wounds following reconstruction of the vascular and neural
structures, wounds with exposed tendinous and osseous structures, open
abdominal wounds, wounds on the back, chest and buttocks, partial
thickness burns, and over split-thickness skin grafts (STSGs) to promote
graft take

Recent studies have reported on the beneficial use of NPWT/ROCF in

temporizing combat wounds in preparation for delayed primary closure.
Adjunctive use of the therapy has been shown to decrease time to
closure, reduce amputations, reduce infection, and decrease labor
required for dressing changes

Geiger et al. reported use of NPWT/ROCF during OIF in 46% of admitted

extremity wounds during March 2003, versus over 90% of admitted
wounds during September 2003
Use of Vacuum-Assisted Closure Negative Pressure Wound Therapy in Combat-Related Injuries Literature Review-Military Medicine, Mar 2010 by Hinck, Daniel, Franke, Axel, Gatzka, Friedrich

Cost Savings with VAC Therapy in Trauma Wounds

There are 150,000 Trauma wounds annually that are appropriate for
treatment with VAC Therapy (NPWT)
70% (106,000) exist in Hospitals and LTAC
The remaining 30% exist in SNFs, WCC, HHA, PCP Offices

An estimated 89,000 Trauma wounds were treated with NPWT in 2009

86% were treated in Hospitals and LTAC
The remaining 14% were are treated in SNFs, WCC, HHA, PCP Offices

Literature shows VAC Therapy may provide savings in trauma wounds of

$31,842 (for Abdominal Compartment Syndrome patients) & savings of
$33,040 (for Limb Salvage patients)

This can account for an overall savings of up to $1.2M for Limb

Salvage Patients

1) L.E.K. - U.S. NPWT / V.A.C. Market Landscape

2) Kaplan M. Managing the open abdomen. Ostomy Wound Management, Vol.50, Issue 1a (Suppl), January
2004
3) The Economic Value of Negative Pressure Wound Therapy. Niezgoda JA, MendezEastman S. Advances in
Skin and Wound Care. 2006 Jan/Feb;19(Suppl 1):315
4) NOTE: Hospital expenses were extrapolated from 2008 HCUP data. HCUP lists Acute daily hospital costs at
$1,993. See http://hcupnet.ahrq.gov/Days formula: 30-40.75 = 10.75. Expenditures formula: 10.75 *
$1,993.48 = $21,425

Limb Salvage-VAC Therapy Reduces Amputation Rates & Accelerates

Wound Healing which can lead to savings
VAC Therapy Amputation Rates compared to rates without
VAC Therapy

Limb Salvage Patients

Number of Trauma Wounds
Cost of an Amputation per patient
$
Limb Salvage Patients
Rate of Amputation

VAC Therapy

Savings (0.45-0.06) * $33,040* 89,000

89000
33,040
No VAC Therapy

0.06

0.45

1,146,818,400

Use of Vacuum-Assisted Closure Negative Pressure Wound Therapy in Combat-Related Injuries - Literature Review-Military
Medicine, Mar 2010 by Hinck, Daniel, Franke, Axel, Gatzka, Friedrich
The Economic Value of Negative Pressure Wound Therapy. Niezgoda JA, MendezEastman S. Advances in Skin and
Wound Care. 2006 Jan/Feb;19(Suppl 1):315
NOTE: Hospital expenses were extrapolated from 2008 HCUP data. HCUP lists Acute daily hospital costs at $1,993. See
http://hcupnet.ahrq.gov/Days formula: 30-40.75 = 10.75. Expenditures formula: 10.75 * $1,993.48 = $21,425

Benefits of VAC Therapy in Trauma Wounds:

Reduced Amputations & Limb Salvage

Limb Salvage-VAC Therapy Reduces Amputation Rates & Accelerates

Wound Healing

Of the wounds sustained in OIF/OEF, an estimated 53-65% are extremity injuries.

The majority of extremity injuries are soft-tissue wounds (53%), followed by
fractures (26%)

Typically, these types of injuries are survived and are therefore the focus of
prolonged wound treatment. Extremity injuries determine over 50% of surgical
procedures and account for enormous economic costs as a result of long-term
treatment and rehabilitation

Limited literature described amputation rates during the Vietnam War, with
reported rates generally varying from 8% to 45% of major limb injuries

In limb salvage, NPWT/ROCF has been used to help stabilize the wound, generate
a healthy wound bed, decrease limb swelling, and prepare the wound for closure.
Geiger et al. reported amputation in 4 of 62 patients (6%) and limb salvage
rates of 93.6% at one of the busiest combat receiving hospitals. Peck et al.
documented a 3% early amputation rate in 134 patients with combat-related
vascular extremity injuries

Authors attributed improved limb salvage rates to advances in wound

management and reconstructive techniques. Evidence suggests reduced time to
closure may influence the functional outcome in limb salvage. Peck et al. observed
that NPWT/ROCF accelerated wound contraction and granulation formation, both of
which facilitated delayed primary closure or secondary coverage with skin grafting
Use of Vacuum-Assisted Closure Negative Pressure Wound Therapy in Combat-Related Injuries Literature Review-Military Medicine, Mar 2010 by Hinck, Daniel, Franke, Axel, Gatzka, Friedrich

Limb Salvage-VAC Therapy Reduces Amputation Rates & Accelerates

Wound Healing
VAC Therapy Amputation Rates compared to rates without
VAC Therapy
50.00%

45%

% Amputation

45.00%
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%

6%

V.A.C. Therapy

No V.A.C. Therapy

Amputation Rate

Use of Vacuum-Assisted Closure Negative Pressure Wound Therapy in Combat-Related Injuries - Literature Review-Military
Medicine, Mar 2010 by Hinck, Daniel, Franke, Axel, Gatzka, Friedrich

In another retrospective review of below knee amputation casesHospital days were lower by 82% for patients with
V.A.C. Therapy vs. other standard wound care
A retrospective study of hospitalized patients prescribed
with possible below knee amputation yielded these results:
35
30

82%

Days

25
20
15
10
5
-

17days

31 days

(n= 10)

(n= 10)
V.A.C. Therapy

Other standard
wound care

Hospital days

The Economic Value of Negative Pressure Wound Therapy. Niezgoda JA, MendezEastman S. Advances in Skin and
Wound Care. 2006 Jan/Feb;19(Suppl 1):315

In another retrospective review of below knee amputation casesHospital cost was lower by 45% for patients with V.A.C. Therapy vs.
other standard wound care
A retrospective study of hospitalized patients prescribed
with possible below knee amputation yielded these results:
80,000

Hospital day: 31 days

70,000

45%

USD

60,000
50,000
40,000

Savings of
$33,040 per
patient

Hospital days: 17
days

30,000
20,000
10,000
-

$ 73,160

$ 40,120

(n= 10)

(n= 10)
V.A.C. Therapy

Other standard
wound care

Hospital Cost

The Economic Value of Negative Pressure Wound Therapy. Niezgoda JA, MendezEastman S. Advances in Skin and
Wound Care. 2006 Jan/Feb;19(Suppl 1):315
NOTE: Hospital expenses were extrapolated from 2008 HCUP data. HCUP lists Acute daily hospital costs at $1,993. See
http://hcupnet.ahrq.gov/Days formula: 30-40.75 = 10.75. Expenditures formula: 10.75 * $1,993.48 = $21,425

VAC Therapy Reduces Infections

Wartime missile injuries are frequently high-energy wounds that devitalize

and contaminate tissue, with high risk for infection and wound
complications
Often the anecdotal infection rates are as high as 80%
Wounds were closed definitively before discharge in all Iraqi patients
treated for such injures at our hospital. A novel wound management
protocol was developed to facilitate NPWT, and patient outcomes were
tracked
Treatment and outcomes data from September 2004 through May 2005
were analyzed retrospectively
There were 88 high-energy soft tissue wounds identified in 77 patients.
NPWT/ROCF provided protection of the wound from the ward environment,
decrease in nursing labor time, and reduction of infection from
anecdotal 80% to documented 0%
According to Leininger et al., the most significant benefit of NPWT/ROCF in
wartime extremity wound treatment was prolonged protection of the
wound from the ward environment. The closed dressing system may help
minimize the spread of infection from host country to homeland treatment
areas, reducing the risk of nosocomial infection on both fronts.
Experience with wound VAC and delayed primary closure of contaminated soft tissue injuries in Iraq.Leininger
BE, Rasmussen TE, Smith DL, Jenkins DH, Coppola C.
Use of Vacuum-Assisted Closure Negative Pressure Wound Therapy in Combat-Related Injuries - Literature
Review-Military Medicine, Mar 2010 by Hinck, Daniel, Franke, Axel, Gatzka, Friedrich

Benefits of VAC Therapy in Trauma Wounds:

Reduced Time to Closure

VAC Therapy Reduces Time to Closure Rates

During the first 4 months of OIF (2003), Geiger et al. showed a time
from arrival to definitive closure of 12 days with NPWT/ROCF
compared to 17 days for patients not treated with NPWT/ROCF
During the period of April to December 2005, time to wound closure
had decreased to an average of 3 days, based on limb edema and
presence of granulation formation
Geiger et al. noted that earlier application of NPWT/ROCF in extremity
wound treatment appeared to reduce time to closure. Considering the
costly nature of wartime missile injuries in terms of personal and
financial resources, reducing time to closure may result in cost
savings to the system
Leininger et al. observed that length of hospital stay was substantially
reduced with NPWT/ROCF compared to closure via secondary
intention or delayed grafting, and reported a mean time to closure of
4 days in 77 Iraqi patients with 88 soft-tissue wounds

Use of Vacuum-Assisted Closure Negative Pressure Wound Therapy in Combat-Related Injuries Literature Review-Military Medicine, Mar 2010 by Hinck, Daniel, Franke, Axel, Gatzka, Friedrich

V.A.C Therapy Reduced Wound Healing Time by 14 days

A retrospective chart review of 62 patient with extremity injuries
yielded the results below:
NPWT=62
18
16

Days

14
12
10

14
days

17

12

6
4
2

0
V.A.C. Therapy
Apr-Dec 2005

V.A.C. Therapy
Jan-Apr 2005

No V.A.C.
Therapy

Use of Vacuum-Assisted Closure Negative Pressure Wound Therapy in Combat-Related Injuries - Literature ReviewMilitary Medicine, Mar 2010 by Hinck, Daniel, Franke, Axel, Gatzka, Friedrich
Geiger et al. War wounds: lessons learned from Operation Iraqi Freedom. 2008

Benefits of VAC Therapy in Trauma Wounds:

Reduced Nursing Time

VAC Therapy Reduces Nursing Time

Reported frequency between NPWT/ROCF dressing changes varied

from 2 to 4 days, as opposed to the prior regimen of 2-3 times daily
bedside gauze dressing changes. Authors reported the reduced
dressing change frequency allowed time to perform NPWT dressing
changes in the cleaner, OR environment

Machen et al. recommended that NPWT/ROCF systems be available in

all combat support hospitals tasked with managing large numbers of
combat patients for extended time. Studies reported NPWT/ROCF
increased productivity and time for surgeons to treat more critical
patients. Reduced bedside nursing time may indicate cost savings. In
evacuee cases, the 1 to 2 day interval between dressing changes
could be the length of evacuation, allowing therapy initiation in the
field followed by the first dressing change in the home country

Use of Vacuum-Assisted Closure Negative Pressure Wound Therapy in Combat-Related Injuries Literature Review-Military Medicine, Mar 2010 by Hinck, Daniel, Franke, Axel, Gatzka, Friedrich

V.A.C Therapy Reduces Nursing Hours by

54% Compared to Modern Wound Dressings
A randomized control trial of acute and chronic wound
patients yielded the results below:
P=0.04, NPWT=32, MWT=33
7
6

Hours

54%

6.3

3
2

2.9
1
0
Nursing hours

V.A.C. Therapy

Modrern Wound Dress.

Hydrocolloid, Alginate, Eusol

Braakenburg A, Obdeijn MC, Feitz R, van Rooij IA, van Griethuysen AJ, Klinkenbijl JH. The clinical efficacy
and cost effectiveness of the vacuum-assisted closure technique in the management of acute and chronic
wounds: a randomized controlled trial. Plastic and Reconstructive Surgery. 2006 Aug;118(2):390-7

Benefits of VAC Therapy in Trauma Wounds:

Faster Time to Fascial Closure in ACS
Patients

23

Abdominal Compartment Syndrome-Causes

Blunt Trauma

Rapid deceleration (motor

vehicle crash) results in
avulsion of the small
branches of major vessels

A blow to the major vessels

can result in an internal tear
leading to vessel rupture

Damage to organs can result

in massive hemorrhaging or
loss of organ contents such
as feces or digestive enzymes

Penetrating Trauma

Occurs from a stab,

impalement or missile

24

Complications Associated with ACS

Retraction & loss of fascia

Retraction & loss of rectus
abdominus muscle
Necessitates placement of
abdominal mesh for hernia
control and stability of
abdominal contents.
Maintaining a clean wound
environment
Abdominal trauma
Hemorrhage
Peritonitis
Emergency aortic surgery
Intra abdominal packing
Forced abdominal closure, etc.

Photo: Kaplan M et al. Guidelines for the Management of the

Open Abdomen. Recommendations from a multidisciplinary
expert advisory panel. Wounds, a compendium of clinical
research and practice Supplement, 1-22 (2005).

25

Abdominal Compartment Syndrome

Patients with open abdomens have 30 40% chance of

developing multi-organ failure
Overall mortality rate open abdomen > 25%
Incidence of abdominal dehiscence (following any
laparotomy): 0.4 3% with a mortality rate of 15-20%
Incidence ACS: 15% in cases of acute abdominal trauma
with a 62.5% mortality rate
One of the major cost drivers in treating an open abdomen is
the length of ICU stay
Treatment costs estimated between $33,800 $232,000

Swan M, Banwell PE. Topical Negative Pressure: Advanced Management of the Open Abdomen. The Oxford
Wound Healing Society. 2003.
Kaplan, et al. Guidelines for the Management of the Open Abdomen: Recommendations from a multidisciplinary
expert advisory panel. Suppl Wounds Oct 2005

26

The goal of open abdomen procedures is trending

toward achieving primary fascial closure

Awareness of intra-abdominal hypertension, abdominal

compartment syndrome and abdominal infections has led to
increased frequency of open abdomen procedures.

Leaving the abdomen open has been shown to increase

survival.

Cost savings and better quality of life outcomes are shifting

the treatment paradigm toward achieving primary closure
during the same admission versus the traditional goal of a
planned hernia with reconstruction.

ABThera Open Abdomen Negative Pressure

Therapy System
A Temporary Abdominal Closure system that helps
you take control early when managing a challenging
open abdomen and achieve primary fascial closure.
Actively removes fluid and helps reduce edema
Provides medial tension which helps minimize
fascial retraction and loss of domain4
Helps isolate viscera and abdominal contents
from external environment
Provides separation between the abdominal wall
and viscera, protecting abdominal contents
Removes fluid and infectious materials from the
abdomen
Allows rapid access for re-entry and does not
require sutures for placement

27

28

Percentage fascial closure

VAC Therapy Improves Fascial Closure Rates by 21%

p<
0.001

90
80
70

79

60

Total patients with

facial closure N= 545
(43%)

50

58

40
30
20

44

33
18

10
0

Polypropylen
e

Polyglactin/

Bogota
bag

Vacuum
pack

V.A.C.
Therapy

polyglycoli
c

Compilation of data various TAC techniques for

managing the open abdomen

Kaplan M, et al. Guidelines for the Management of the Open Abdomen. Recommendations from a
multidisciplinary expert advisory panel. Wounds, a compendium of clinical research and practice. Suppl, 122 (Oct 2005).

VAC Therapy reduces ICU days, ventilator days &

hospital LOS leading to cost savings
V.A.C. Therapy

Total cost savings for

V.A.C. Therapy: $31,842

Vacuum pack

45

370000

35

p < 0.05

USD ($)

Days

40

30
25

350000
340000

20
15
10

360000

19

26

12.75

20

30

40.75

330000
320000

5
0

326,734

358,576

310000
ICU days

Ventilator days

Hospitals days

Kaplan M. Negative pressure wound therapy versus V.A.C. Therapy a two year study of patients at high
risk for ACS. Abstract presentation. First International World Congress on Abdominal Compartment
Syndrome. Australia. December 6-8. 2004
Kaplan M. Managing the open abdomen. Ostomy Wound Management, Vol.50, Issue 1a (Suppl), January 2004

29

Back-Up

SOURCE: L.E.K. - U.S. NPWT / V.A.C. Market Landscape

SOURCE: L.E.K. - U.S. NPWT / V.A.C. Market Landscape

The positive healing effects of NPWT/ROCF reported by military

medical personnel in hospitals prompted efforts to validate the
therapy on military aircraft. Approval of the NPWT/ROCF device for
medical evacuation flight treatment allowed evacuated soldiers access
to the therapy earlier on in the course of care. According to Powell et
al. use of NPWT/ ROCF during aeromedical transport potentially
improves pain management, facilitates wound healing, decreases
infection rates, simplifies wound care in flight, and allows earlier
aggressive treatment for war wounds. The closed system may reduce
the risk of wound fluid contamination for staff and patients. The
longer dressing change frequency allows an uninterrupted wound
conditioning chain.

Use of Vacuum-Assisted Closure Negative Pressure Wound Therapy in Combat-Related

Injuries - Literature Review-Military Medicine, Mar 2010 by Hinck, Daniel, Franke, Axel,
Gatzka, Friedrich