“Vacuum Assisted Closure”(VAC) had dramatically changed ...
Vacuum Asısted Closure And Anxıety
Furkan Erol Karabekmez MD, Mustafa Keskin MD, Ahmet Duymaz MD, Ertan Yilmaz MD, Zekeriya Tosun MD, Nedim Savacı MD
INTRODUCTION: Introduction of the “Vacuum-Assisted Closure” (VAC) device (VAC® KCI International, San Antonio,TX, USA), pioneered by Argenta and Morykwas , had dramatically changed the approach to the management of acute and chronic wounds (1). After we realized that some patients were not willing to continue prosedure we decided to investigate anxiety level of these patients. The aim of this study was to verify the possibility of different anxiety levels in individuals in whom the VAC device was applied.
PATIENTS AND METHOD: Twenty patients with lower extremity wounds recruited to the Plastic Surgery clinic were enrolled to the study. Patients were between the ages of 18 and 80 years old. To standardize the study and reduce the bias, only patients with non-diabetic wounds at the lower extremities were included to the study. The patients were divided randomly into two groups according to the way they received the wound management: either with VAC device or standard moist wound care. VAC was used after a wound debridement in 10 patients in the first group. Psychological evaluations were done on subjects on the day before VAC application and on the 10th day of the treatment. Anxiety was measured with the Hamilton Rating Scale for Anxiety(HAM) and with the State Anxiety Inventory(SAI) tests(2,3). Same measurements were also done in 10 patients with similar wounds but managed with classical therapies for comparison.
RESULTS: Both groups showed a significant increase in anxiety levels, however when the increase percentages of two groups for both tests were compared with Mann-Whitney U Test the increase was significant in the VAC group.(Table)
| |Control groups |VAC groups |p |
|SAI |4.53±5.65 |30.24±27.02 |0.004 |
|HAM |16.70±15.15 |80.12±79.48 |0.002 |
Table. Comparison of the control and VAC groups regarding to percentage differences of mean SAI and HAM scores.
CONCLUSION: While previous interest focused mostly on medical and technical aspects of vacuum assisted closure, psychosocial aspects should also be explored. In this preliminary report it is shown that VAC therapy has the potential to increase the anxiety level which is already been raised by the etiological factor and hospitalization. A significant anxiety disorder should be identified promptly by the surgeon and close follow-up by the team is an essential part of the overall treatment plan. Although the VAC therapy is very effective in treating lower extremity wounds, concerns should be given for possible accompanying psychological side effects.
REFERENCES
1. Argenta LC, Morykwas M. Vacuum-assisted closure. A new method for wound control and treatment: clinical experience. Ann Plast Surg 38:(6):563–576,1997
2. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 32:50–55,1959
3. Spielberger CD, Gorsuch RL, Lushene RE. Manual for the State-Trait Anxiety Inventory. Consulting Psychologist Press, Palo Alto, CA, USA 1983.
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