Vacuum assisted wound closures in gynaecologic surgery.

Vacuum assisted closure and negative pressure (NP) dressings are innovative forms of wound management used in multiple fields of medicine, including surgery. We review here the current literature in this area relevant for the gynaecologist. Negative pressure dressings increase blood flow to the wound, decrease bacterial counts, decrease tension on wound edges, and increase the formation of granulation tissue. Until recently, use of NP dressings has been contraindicated in wounds that have been previously radiated or that have necrotic tissue, an infection, an open fistula, an underlying malignancy, or an exposed blood vessel. In this review, we discuss the use of negative pressure for the treatment of abdominal wounds, including those associated with dehiscence, fistula, and prior radiation. We also discuss the use of NP dressings in gynaecologic oncology, including the vulvar and perineal areas. Finally, we outline the basics of applying NP dressings, and discuss pressure settings, "foam counts," debridement, and interface dressings to optimize the benefits of vacuum dressings. When used in the appropriate setting, NP dressing is a unique and important modality of treatment in gynaecology.