VAC Therapy

Vacuum assisted closure has been around for a while now, and I have certainly witnessed its ability to close a gnarly wound. It really does appear to work better than the old fashioned wet-to-dry dressings. But I've wondered what really goes into the wound healing process using this system. I've learned that the negative pressure dressing applies forces inducing macrostrain and microstrain.

Macrostrain you see immediately when the suction is turned on and the wound edges are brought closer together. The suction pulls off infectious materials and edema. The pressure of the sponge against the wound bed also induces microstrain, essentially stretching of cells. The cells respond to this stain by expressing different receptors on the cell surface that ultimately promote healing. Through this there is an increase in cell proliferation, extracellular matrix production, wound perfusion, and the subsequent formation of granulation tissue.

For those that haven't worked with VAC therapy, you place foam directly on the wound bed and cover with a transparent plastic adherent. Then you have to snip a few holes in the plastic where you will attach the suction tubing. The fluids are pulled from the wound, through the sponge, and travel through the tubing into a canister. Above is a picture a VAC sponge, applied to presumably a sacral decub, with suction turned on. The little ring in the middle the black sponge is part of the tubing- this ring/circle is what you place over the holes you made. You can also see the plastic around the sponge on normal skin. When VACs are removed, you see the characteristic little bumps or ridges formed by the sponge in [hopefully] healthy tissue.

Spine fractures

I've found that a lot of people think paralysis occurs when they hear someone "broke their back." From my experience, though, most of the spine fractures I see do not result in paralysis. Of course, a severe fracture absolutely can result in paralysis, but I find the majority of spine fracture are not that severe.



There are different types of fractures, which can involve different levels and different parts of the vertebra. Seemingly the most benign is a transverse process fracture (bony projections off the back of the vertebra, which are essentially non-weight-bearing elements). Most problems occur when the vertebral body is involved. But even with compression fractures of the vertebral body, surgery doesn't often seem required and usually treatment is a brace. Surgery would likely occur in cases involving neuro deficits, parasthesias, and/or bony fragments impinging on the spinal canal. In my previous job, in Interventional Radiology, we did a lot of vertebroplasties and kyphoplasties for compression fractures. In my current position, the Spine team almost always opts for a brace. I think I've only had 1 patient get a verteroplasty here. That is, of course, if surgical decompression isn't needed. So treatment may vary according to facility. Depending on the severity of the injury, you may get a brace, you may get a vertebroplasty/kyphoplasty, or even surgical decompression. But it may help to know if you "break" your back, it does not mean guaranteed paralysis.

Impact of drinking alcohol on healthcare

I just read an article that came out this month about alcohol use and it's impact on the healthcare system. I was quite surprised to learn that high-risk alcohol drinkers were less likely to access healthcare than other drinkers and that the level of risky of drinking did not predict healthcare usage.

First, I was surprised by this based on my observations in the hospital. I see a lot of people admitted as a result of heavy drinking and figure they wouldn't be in the hospital if it weren't for the fact that they had been drinking. Second, my surprise was compounded when the article started out discussing how risky alcohol use is associated with over 60 medical conditions, such as hypertension, liver disease, or coronary artery disease. And that, with 3/10 American adults engaging in risky drinking, exceeding the low-risk drinking pattern is 4x more prevalent that diabetes or 10x more prevalent than cancer. Wow. Impressive numbers, I think. And to me those impressive numbers would correlate to healthcare usage. So interesting that it doesn't!