1.1 The VAC Veraflo Therapy system shows promise for treating acute infected or chronic wounds that are not healing. However there is not enough good-quality evidence to support the case for routine adoption.
1.2 Research in the form of a randomised controlled trial is recommended to show clinically meaningful benefits for the VAC Veraflo Therapy system (wound instillation with negative pressure therapy) compared with negative pressure wound therapy alone. A key outcome should be time to wound closure.
Why the committee made these recommendations
Acute infected or chronic wounds are normally cleaned, dead or infected tissue removed, and dressed. Chronic non-healing wounds are usually treated with advanced wound care (such as adsorptive or moisture-donating advanced wound dressings). Some wounds are treated with negative pressure therapy, which uses a pump to draw out excess fluid from the wound. VAC Veraflo Therapy system would generally be considered as an alternative to negative pressure wound therapy without wound instillation.
The VAC Veraflo Therapy system comprises a dressing that covers the wound, attached by tubes to a machine, which delivers the therapy. It uses negative pressure therapy, but also slowly introduces cleansing fluid onto the wound bed (wound instillation therapy). The fluid stays for a time and then is slowly drawn away from the wound, along with wound and tissue fluid. The fluid is delivered in automated treatment cycles allowing the wound to be repeatedly cleaned without needing to remove the dressing.
The clinical evidence for VAC Veraflo Therapy system is mostly low quality. The best available evidence does not show any clinical benefit over negative pressure wound therapy without instillation. Also, the evidence is from the US and does not reflect the way VAC Veraflo Therapy system is used in the NHS. There was not enough evidence to compare VAC Veraflo Therapy system with advanced wound care, and the comparison is of limited relevance because advanced wound care is used in a different part of the care pathway.
Although there are potential benefits for patients and the NHS, more evidence is needed to be certain of VAC Veraflo Therapy system's clinical effectiveness and potential for cost savings compared with negative pressure wound therapy in the NHS. Therefore NICE recommends further research.