Vacuum assisted closure (VAC) therapy is now a common sight in plastic surgery departments for the management of difficult wounds, to encourage granulation tissue formation, reduce wound size and facilitate closure or reconstruction. The combined use of VAC dressing with instillation of topical irrigation solutions is, however, less widely practiced and the indications and benefits of such therapy less well established. This paper attempts to draw preliminary consensus guidelines through the opinions of a panel of European and American surgeons with considerable experience of this technique. In the end, nine consensus statements are presented that will guide the appropriate choice and use of instillation fluids. Although the paper is a useful starting point for surgeons considering this variation on conventional VAC therapy, there is still plenty to be learnt about the efficacy of, and indications for, this technique. 

Negative pressure wound therapy with instillation: international consensus guidelines.
Kim P, Attinger C, Steinberg J, Evans K.
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Patrick Addison

St John's Hospital, Livingston, UK.

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