**11. Tissue viability services [25]**

The concept of tissue viability nurses is relatively new though the idea originated in the 1980s. It covers all aspects of skin and soft tissue wounds. Although surgical wound management is a major part of their role, it is not their sole field of expertise. They also cover various soft tissuerelated areas such as pressure sores and chronic leg ulceration. In addition to their bedside role, they provide education to the entire healthcare team. Across the UK, they are also working on preventing common hospital-related skin problems like pressure sores, thereby saving costs in the long term. Their role extends into the community where they provide support to district and practice nurses and help them to choose the correct dressing material and other essential tools for wound healing. The Tissue Viability Society has been established since 2014 and it is considered an excellent forum to discuss all new techniques and materials used for wound healing [26].

**Figure 1.** Prospective evaluation of vacuum-assisted closure in abdominal compartment syndrome and severe abdominal sepsis, *J Am Coll Surg*. 2007; **205**: 586–592 (Courtesy of KCI medical).

### **11.1. Vacuum-assisted closure (VAC) therapy and its role in wound healing**

VAC therapy is a simple but effective method of promoting rapid healing. It is currently considered to be an effective means of managing large complex acute and chronic wounds (**Figures 1** and **2**) [27].

**Figure 2.** Vacuum dressing or small oozing wound (Courtesy of WWW.REHABPUB.COM).

VAC is an active wound therapy that was first described in 1997 by Morykwas and Argenta [28]. The system applies negative pressure to the wound bed via an open-cell polyurethane foam dressing [28]. The foam will be in direct contact with the wound and connects to a canister via a suction tube. An effective airtight seal is mandatory for the system to function.

Treatment objectives

nurses in the general practice and this allows appropriate resource allocation and provides a good service for the people who really need it. Moreover, it promotes recovery of

The concept of tissue viability nurses is relatively new though the idea originated in the 1980s. It covers all aspects of skin and soft tissue wounds. Although surgical wound management is a major part of their role, it is not their sole field of expertise. They also cover various soft tissuerelated areas such as pressure sores and chronic leg ulceration. In addition to their bedside role, they provide education to the entire healthcare team. Across the UK, they are also working on preventing common hospital-related skin problems like pressure sores, thereby saving costs in the long term. Their role extends into the community where they provide support to district and practice nurses and help them to choose the correct dressing material and other essential tools for wound healing. The Tissue Viability Society has been established since 2014 and it is considered an excellent forum to discuss all new techniques and materials used for wound

**Figure 1.** Prospective evaluation of vacuum-assisted closure in abdominal compartment syndrome and severe abdomi-

nal sepsis, *J Am Coll Surg*. 2007; **205**: 586–592 (Courtesy of KCI medical).

the relatively fitter patient population.

354 Wound Healing - New insights into Ancient Challenges

**11. Tissue viability services [25]**

healing [26].

A. Removal of excessive exudate and promoting a moist rather than wet environment for wound healing [27].

B. Increase angiogenesis which promotes granulation formation [28].

C. Ability to promote healing in complex wounds and wounds that fail to heal with the conventional methods [27, 28].

Wounds that can be treated with VAC therapy [29]

A. Pressure ulcers


### **11.2. Adjunctive measurements contributing to wound management**

1. Ultrasound waves, electrotherapy or laser therapy. These adjuncts have always been thought to contribute towards better wound management. In a recent RCT, Cullum et al. concluded that there is lack of sufficient reliable evidence to draw conclusions about the contribution of laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy to chronic wound healing [30].

2. Hyperbaric oxygen therapy. Tissue hypoxia is one of the characteristics of chronic wounds. Therefore, means of increasing O2supply to tissues could potentially improve chronic wound healing. In a recent Cochrane review of 12 randomised trials, it was concluded that hyperbaric O2 therapy can improve the chance of healing of diabetic foot ulcers only on short term but not on long term bases [31]. It can also reduce the size of wounds caused by chronic venous insufficiency but it was found to have no effect in wounds/ulcers caused by arterial insufficiency [31].
