The Wound – Vac: Can We Afford To Be Effective?

Jed H. Horowitz, MD, FACS
Article by
Orange County Plastic Surgeon

The Wound – Vac: Can We Afford To Be Effective?

Jed Horowitz, M.D.

       Michael Strauss, M.D.

     ABSTRACT

 

Our early experience with 49 patients treated with The Wound-Vac (Kinetic Concepts, Inc. KCI) was previously described at the 1999 Baromedicine Winter Symposium.  Our experience now includes more than 80 patients.  We have expanded the indications for treatment and have increased our experience with the portable Vac for use with our outpatients.  New issues regarding Medicare and insurance reimbursement have surfaced further challenging our ability to use this device and increasing our need to demonstrate ongoing cost/effectiveness.

 

The physiologic basis of the Vac and the specific methods of application have been previously described. We have been selective in the application of this device and have restricted its application to the following groups of patients:

 

Moderately large (3800 sq. cm) to small pressure sores in patients who are non-surgical candidates.

Intra-operative stabilization of skin grafts on the back and trunk.
Exposed bone tendon or other vital structures in anatomic locations or patients who do not qualify for flap reconstruction.
Patients who are refractory to other wound products or treatment methods including: moist wound products, mechanical dressing devices, wound healing factors.
Adjunctive use with HBO for many of the indications in #4.
Large painful wounds otherwise requiring frequent excruciating dressing changes.

 

The Wound-Vac has successful in treating our patients in all of these categories.  Many patients would still have persistent difficult wounds with expensive, time intensive, uncomfortable treatments without the application of this device. Recent changes in Medicare reimbursement and insurance authorization have made the outpatient use of the Vac difficult or impossible.  In our experience this is financially short-sited and clearly not in the best medical interests of our patients.  It is the physician’s responsibility to be judicious in the application of new medical technology and to continue to demonstrate the need and effectiveness of these tools in the care of our patients.

 

— Dr. Jed Horowitz, MD, FACS