Abstract
Significance: A high bacterial load interferes with the healing process of a wound. Vacuum-assisted closure (VAC) is a wound healing therapy that utilizes a dressing system that continuously or intermittently applies a negative pressure to the wound surface. Recent Advances: VAC stimulates wound healing, but data on changes in the bacterial load and changes in the bacterial spectrum are scarce. Critical Issues: While VAC supposedly removes bacteria from the treated wounds and therefore reduces the risk of infection, this relationship has not yet been clinically proven. If VAC increases the bacterial load instead of decreasing it, then this may be a reason not to use VAC on certain types of wounds. Only seven small and heterogeneous studies reporting on the relationship between VAC usage and the bacterial load and type of bacteria in the treated wounds in clinical practice were found in the literature. Although there is some low quality evidence that VAC therapy does not change the bacterial load, no definite conclusions on changes in the bacterial load and type of bacteria during VAC can be drawn. Future Directions: Prospectively monitoring changes in the bacterial load and bacterial spectrum in patients that will receive VAC treatment on indication might be an effective way to find out whether it should indeed be used on specific wounds.