V.A.C. is also known as vacuum assisted therapy. This treatment involves placing a foam dressing on the wound that is then attached to suction. The wound is then suctioned continuously for the first 48 hours, and then intermittently thereafter. In theory, the procedure hastens cleaning by removing harmful substances including bacteria. The 11 major studies advocating V.A.C. have major flaws however. For example, many of the studies showing a benefit of V.A.C. compared the device to older therapies such as wet dressings. Recently, however, the therapy has come under attack and has been shown to be not as effective as other therapies and in some cases may be more harmful in subjecting the wound to suction. In addition, the device is costly, and therapy requires each patient to be immobile and attached to device for long periods of time.
There are many issues that may be addressed in this case. The primary one is our enthusiasm to jump to newer therapies that may not be fully studied. Is it our obligation to adapt to the newer therapies once the research has begun to show a benefit. Should we remain with the older therapies until definitive research is available. If we remain with older therapies, are we negligent in not using what may possibly be the best treatment?
Sunday, December 2, 2007
Case 4
A diabetic patient presents with a foot ulcer and the following Xray. What is the recommended initial treatment?
A:
IV Ciprofloxaxcin for 48 hours,
followed by 12-14 weeks of oral therapy may be adequate therapy for a diabetic foot ulcer that involves the bone. Of course, the therapy may need to be changed to be specific to the culture and sensitivity obtained. Surgical treatment may be required if there is not adequate vascularization or if there is not adequate response in the bone involved.
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