If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password
If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password
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.
