practice s JOURNAL OF WOUND CARE VOL 20, NO 1, JANUARY 2011 35 Negative pressure wound therapy as an adjunct to compression for healing chronic venous ulcers l Objective: To determine the effcacy of negative pressure wound therapy (NPWT), when used in combination with compression bandaging, for healing chronic resistant venous ulcers. l Method: In this pilot study, seven patients (with a total of 12 chronic resistant venous ulcers) received adjunctive NPWT and compression bandaging for 4 weeks.Their wounds were monitored for a total of 12 weeks. l Results: Dormant ulcers were seen to rapidly develop into healthy wounds, with a granulating base. l Conclusion: This regimen may have a role in stimulating chronic venous ulcers into healing wounds, or in preparing them for skin grafting. topical negative pressure wound therapy; VAC; venous ulcers T he majority of venous ulcers can be healed by a combination of compression therapy and attention to wound bed prepara- tion, 1,2 but 20–30% are refractory. These ulcers may require adjunctive treatments to stimulate healing and occasionally skin grafting is necessary. Negative pressure wound therapy (NPWT) is used in the treatment of acute and chronic wounds both in hospital and in the community. NPWT is report- ed to be associated with improved rates of healing in some wounds 3,4 and appears to be particularly useful in wounds where there is copious production of exudate. 1,5 However, there is no reliable evidence for its use in chronic wounds. 3 Vacuum Assisted Closure (VAC, KCI International Inc. San Antonio, Texas, USA) is an established wound management system that delivers NPWT and aims to improve healing rates possibly by removal of exudate and infammatory mediators. 6 NPWT may have a number of other actions related to wound healing including stimulation of angio- genesis, 6 but further work is needed to clarify how NPWT and VAC infuence healing. The use of VAC has recently been reviewed and results have been published for a wide range of wound types including diabetic foot ulcers, abdomi- nal compartment syndrome, surgical wound infec- tions, traumatic wounds, skin graft fxation, pressure ulcers and leg ulcers. 4,7-9 There is a paucity of literature on the use of NPWT in the management of venous ulceration 10 and no published data on its use in com- bination with compression therapy. The VAC dress- ing system is reported to be well tolerated by patients and there are few documented complications or con- traindications for its use in lower limb ulcers. 7,11 This case series study aimed to investigate the use of NPWT as a simultaneous adjunct to compression bandaging for the treatment of refractory venous ulcers. The primary outcome measures were ulcer surface area and percentage change in wound bed granulation tissue. Materials and method Patients were recruited from a community wound clinic. Inclusion criteria were patients with venous ulcers that had failed to heal despite >12 weeks of 40mmHg compression therapy, an ulcer surface area at least 2cm 2 and less than 10% reduction in ulcer area during a 2-week observation period immedi- ately before the study began. Exclusion criteria were concomitant peripheral arterial disease (ABPI<0.8) and atypical ulcers (e.g. vasculitic ulcers). Ethics approval was provided by the regional eth- ics committee. Patients received adjunctive NPWT, placed under multilayered elastic compression bandages. Com- pression therapy was maintained at 40mmHg. This treatment regimen was continued for 4 weeks, with dressings changed three times per week, as 4 weeks was considered suffcient time to allow for a clini- cally signifcant change in the state of wounds. NPWT was achieved using the VAC freedom device, which was set to continuous suction applied at 125mmHg. Black foam was preferentially used. However, one patient did not tolerate this and required a white foam substitute. After 4 weeks, NPWT therapy was discontinued and treatment continued with multilayered compression bandag- ing for a further 4 weeks. At each dressing change, ulcer surface area was measured using acetate tracings. The nature of the D.C. Kieser, 1 MBChB, PGDipSurgAnat., Orthopaedic Registrar; J.A. Roake, 2 MBChB, DPhil, FRCS, FRACS(Vasc). Professor of Surgery; C. Hammond, 3 RN, DNCert, MN Clinical Nurse Specialist; D.R. Lewis, 2 MB ChB MD EBSQ(vasc) FRACS FRCS. Associate Prof., Vascular Surgeon. 1 Dunedin Hospital, Dunedin, New Zealand; 2 Christchurch Hospital, Christchurch, New Zealand; 3 Nurse Maude Hospice and Hospital, Christchurch, New Zealand. Email: kieserdavid@gmail. com