Dressing change was performed every 3–5 days for 4–8 weeks (average 6♳ weeks) for a total dressing changes of 6–28 (average 14♵ Table 1). An average of 1♴ foams of 18 × 12♵ × 3♳ cm in dimension was used for a single patient (Table 1). The VAC polyurethane foams were applied in a single layer directly on the wound, avoiding their overlapping.
Antibiotics were administered only to patients with clear symptoms and signs of infection according to antibiogram after positive wound swabs. Before applying the device, the lesion was disinfected with sodium hypochlorite solution and then irrigated with saline solution. Therefore, the initial therapeutic modality consisted of a conservative wound management and VAC therapy (KCI Licensing, Inc., San Antonio, TX). Between 6 and 24 months after the trauma, the patients developed grade III and grade IV pressure sores 7 as a consequence of the forced decubitus, the partial immobility and the sensitivity loss. The retention of polyurethane foam fragments within the wound was evidenced in 11 paraplegic patients (10 males and 1 female) aged 24–55 years (average: 30 years).Īccording to medical history, the 11 paraplegic patients presented a medullary trauma that resulted in a condition of paraplegia.
PROTEUS 8 VACCUUM TUBE SKIN
The average time required to achieve complete healing in this patient group was 60 days and this was achieved with different treatment modalities including conservative wound management, surgical debridement and use of skin grafts and flaps associated to VAC therapy. Since January 2004, among all patients presenting chronic ulcers and followed up in our department, a total of 345 patients were treated with a VAC therapy. The focus of this report is on a rare complication of VAC therapy, that is, the retention of foam fragments within the wound that hinder the healing process. In our opinion, the broad diffusion of VAC therapy devices, the great marketing pressure exerted on medical/paramedical personnel and an improper training could lead to inappropriate use that can be harmful. This treatment presents standardised indications in acute and chronic sores 5. The plastic membrane prevents the air penetration and allows creating a partial vacuum in the wound. The foam ensures that the whole surface of the wound is equally exposed to the negative pressure 4, 5, 6. A drainage tube, which is connected to a vacuum source, is then linked in order to suck wound fluids through the foam and these are collected into a tank to be subsequently disposed. The whole area is then covered with a transparent adhesive membrane that adheres tightly to the healthy skin surrounding the wound.
Essentially, the technique is simple to be performed: a piece of foam of porous polyurethane with an open‐cell structure is cut according to the size of the wound and is set on top of the wound itself. The VAC therapy is a sophisticated system that allows carrying out a medication that maintains a humid, closed, sterile and isolated environment 4, 5, 6. in 1993 this technique was successful on 15 patients with open fractures 6. The practice to expose a wound to a negative atmospheric pressure for a long period of time in order to promote wound healing was first described by Fleischmann et al. A wide range of treatments are available to treat chronic ulcers, such as simple or advanced medications, compressive bandage, antimicrobials, surgical revision with grafts or flaps 3 and vacuum‐assisted closure (VAC) therapy 4, 5. Difficult pressure sores are a common problem 2. Nevertheless, wider and chronic sores can require weeks or months to heal, a process that can be further delayed by infections, vascular insufficiency, high local pressure or by other causes 1. The majority of acute pressure sores have the capacity to heal rapidly.
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