Vacuum-Assisted Wound Closure

Abstract

E dwina Paolo, 68, is hospitalized with a nonhealing saphenous vein donor site on her left leg three months after a coronary artery bypass graft. The distal portion of her wound is covered with fibrin, and bone is exposed. After several weeks of traditional wound care and moist dressings, vacuumassisted closure (VAC) therapy is initiated to prepare the wound bed for a skin graft. The nurse caring for Ms. Paolo cuts a piece of sterile polyurethane foam sponge to fit the wound cavity. She places a tube with end and side ports inside the sponge and connects it to a disposable canister loaded into a programmable vacuum pressure pump.1.2 She covers the foam dressing and the embedded evacuation tube with a transparent film to hold the sponge and tubing in place, to ensure an airtight seal and to maintain a moist environment. X Negative suction pressure-pressure lower i than that of the atmosphere at sea level-is applied by the VAC pump at 75 mmHg, increasing in increments of 25 mmHg (to prevent pain during therapy) to a target pressure of 125 mmHg. The device can be programmed to deliver an amount of negative pressure appropriate to a patient's comfort level and the characteristics of the wound. Continuous negative pressure is applied for 48 hours; then the sponge is changed and treatment is continued. For two weeks, Ms. Paolo receives therapy with intermittent negative pressure-suction is turned on for five minutes and off for two minutesto remove excess fluids, promote formation of granulation tissue, and restore capillary flow.