Expert Pointers On Negative Pressure Wound Therapy

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Lee C. Rogers, DPM, used VAC therapy until the wound bed was completely prepared and granular as shown in the above photo.
Here one can see a meshed graft on the dorsum of the foot covering a chronic wound. Note that one can minimize the meshed area, giving greater coverage and still avoiding seroma collection when using VAC therapy. (Photo courtesy of Eric Travis, DPM)
Expert Pointers On Negative Pressure Wound Therapy
Expert Pointers On Negative Pressure Wound Therapy
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Author(s): 
Clinical Editor: Lawrence Karlock, DPM

Q: How do you avoid maceration of the wound edges?
A:
Dr. Rogers advises properly cutting the foam so it does not overlap the wound edges, saying it makes a big difference. He also suggests outlining the wound with the VAC drape adhesive to protect the periwound area as he has seen some wound nurses do. In wounds with copious drainage or those in difficult locations, it may not be possible to avoid maceration. In these cases, Dr. Rogers suggests not reapplying VAC therapy for three to four days and perhaps applying Betadine to the wound edges under a wet-to-moist dressing.
To avoid maceration, Dr. Frykberg advises cutting the foam to fit the wound. Sometimes he will use a hydrocolloid border around the wound.
In wounds with heavy exudation, Dr. Travis notes it is difficult to avoid maceration. He notes the importance of getting a good seal with the negative pressure dressing. If the skin around the wound is fragile, he reinforces the area with Duoderm (Convatec), applying it to the area around the wound and applying the adhesive film over that. If hygiene or maceration is an issue, Dr. Travis always increases the frequency of dressing changes with negative pressure therapy.
When wound edges are showing evidence of maceration in between dressing changes, Dr. Travis has used two primary techniques to reverse the problem. After thoroughly drying the surrounding, previously macerated tissue, he either applies stoma paste to protect the tissue before reapplying the VAC drape or applies skin prep and then “window pane” thin hydrocolloid (Duoderm), cut into strips, to the area around the wound.
“Both have yielded excellent results in both outpatient and hospital settings,” notes Dr. Travis.

Dr. Bell is a board certified wound specialist of the American Academy of Wound Management, and a Fellow of the College of Certified Wound Specialists and the American Professional Wound Care Association. Dr. Bell is also the founder and Course Director of the Southeastern Interactive Wound Summit (SIWS), a multidisciplinary annual conference on advanced wound healing.

Dr. Frykberg is the Chief of Podiatry at the Carl T. Hayden VA Medical Center in Phoenix.

Dr. Rogers is the Director of the Amputation Prevention Center at Broadlawns Medical Center in Des Moines, Iowa. He completed a fellowship in diabetic limb preservation and research at the Scholl’s Center for Lower Extremity Ambulatory Research (CLEAR) in Chicago. He has been an investigator for clinical trials involving VAC therapy.

Dr. Travis practices at Beach Podiatry in California. He is on the teaching staff at Fountain Valley Regional Hospital and is involved in the Wound Care Program at La Palma Intercommunity Hospital.

Dr. Karlock (shown at the left) is a Fellow of the American College of Foot and Ankle Surgeons, and practices in Austintown, Ohio. He is the Clinical Instructor of the Western Reserve Podiatric Residency Program in Youngstown, Ohio. Dr. Karlock is a member of the Editorial Advisory Board for WOUNDS, a Compendium of Clinical Research and Practice.




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