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KEYWORDS Dressing / Vacuum / Wound
Provenance and Peer review: Unsolicited submission; Peer reviewed.
Vacuum-assisted closure (VAC) wound dressing is increasingly used to assist closure in various wounds ranging from simple finger pulp defect to complex wounds such as laparostomy or infected sternotomy. The traditional application of direct vacuum therapy can cause discomfort and put the patient at risk of injuring the affected area while mobilising. We describe a novel technique of applying VAC therapy indirectly which is much more comfortable and convenient for the patient while mobilising.
Introduction
VAC wound dressings are increasingly used (Jerome 2007) in the management of various wounds ranging from finger pulp defects (Attar et al 2007) to laparotomy (Bettschart et al 2002, Penn & Rayment 2004) and sternotomy with deep wound infection (Ibrahim & Refaat 2007). VAC therapy improves blood flow, reduces local tissue oedema and removes excess fluid and bacteria from the wound (Venturi et al 2005). It also alters the cytoskeleton of the cells causing increased cellular mitosis (Venturi et al 2005). It is common for the device to be applied straight on to the sponge covering the wound (Direct VAC). When the VAC dressing is applied particularly to a sacral bed sore or diabetic foot, the Therapeutic Regulated Accurate Care (TRAC®) pad tubes protrude from the surface and can cause discomfort to the patient. The patient could be injured at the wound site while mobilising.
Here, the authors describe a convenient method of applying VAC, which we call 'Indirect VAC application technique', which we have found to be more comfortable for the patient. It also avoids the VAC TRAC® pad tubing protruding from the surface and will be useful for routine use in all types of wounds requiring VAC dressing.
Indirect VAC therapy
The VAC dressing kit comprises of a sponge (Figure 1), two big airproof adhesive films, a canister, TRAG® pad tubes for connecting the sponge and the canister and a machine for producing a vacuum. A long thin strip of sponge is required for indirect VAC therapy (or tail VAC). Such a strip can be cut from the main sponge (Figure 1d). Then the remaining main sponge is cut to the correct size to match the contour of the wound. The big...