Short reports and correspondence| Volume 60, ISSUE 1, P99-100, January 2007

A novel technique for vacuum assisted closure device application in noncontiguous wounds

Published:September 05, 2006DOI:
      The vacuum assisted closure dressing (VAC) is an important tool in both the treatment of open wounds and as an initial dressing for skin grafts. We describe a simple technique in which a series of noncontiguous wounds in bilateral lower extremities can be effectively treated with a single VAC suction sponge (per extremity). Previously, such wounds required multiple suction devices – an inefficient use of materials as well as cumbersome for both patient and health care professionals. With our technique, VAC effectiveness remains unaltered, there are no adverse effects, resources are better utilized, and costs are decreased. The patient is an 83-year-old male who was struck by a bus while crossing the street. Shearing forces from the injuries produced scattered areas of epidermolysis, principally involving the medial and lateral pretibial tissues, medial and lateral malleoli, as well as the calcaneus bilaterally. After fixation of the fractures, the initial course of treatment included routine local wound care with dressing changes to areas of soft tissue injury. After the full extent of epidermolysis was determined, it was clear that the wounds would not heal sufficiently without debridement and skin coverage. Consequently, the patient was brought to the operating room for wound debridement and split thickness skin grafting. Fig. 1 demonstrates soft tissue injuries after debridement and prior to skin grafting. Split thickness grafts were then harvested and were secured in place with sutures and stainless steel staples. To further secure the skin grafts, a single VAC suction device was used per extremity. In the usual manner, sponges were precisely cut and fashioned to cover the areas of skin grafting. To prepare the dressing, the intervening normal non-grafted skin was coated with Mastisol® (Ethanol and Gum Mastic, Ferndale Laboratories, Michigan, USA) and covered with an occlusive Opsite® (Smith & Nephew, Florida, USA) dressing to protect the skin. Sponges were then placed on top of this occlusive dressing, permitting the vacuum force to be transmitted over a greater area. The areas of skin grafting are ‘bridged’ by this simple technique, and a single suction unit can maintain the desired negative pressure.
      Figure thumbnail gr1
      Figure 1Patient prior to skin grafting.
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