Cath Lab Digest

How VAC Therapy Can Aid In Post-Amputation Revisions
Another salvage situation in which a more complex application of the VAC is required is during the management of a plantar flap from a revised transmetatarsal amputation or a more proximal foot amputation.

In this clinical scenario, one is dealing with delicate tissue at both the remaining stump site as well as the salvaged portion of the flap. The surgeon is attempting to coax the proximal amputation site and the flap to produce granulation tissue independent of each other.

One would use a typical black sponge over the remaining stump tissue while using a white sponge on the inner surface of the remaining flap. The goal here is to create granulation tissue on the inner aspect of the flap. Once there is adequate granulation on the inner portion of the flap, one can utilize negative pressure to adhere the flap to the stump. Use a white sponge on this more delicate tissue to avoid any chance of injury. Should there be exposed vessels, one may consider a white sponge as well in the early stages of managing the stump segment. Both sponges need to be touching during the process.

Once sufficient granulation has occurred on both sides, bring the flap cephalad and place a sponge over the protected flap to facilitate adherence of the flap to the amputation segment. The surgeon may accomplish this in the presence or absence of suturing.

Final Notes
At our institution, we commonly use VAC therapy on most revised amputations on the lower extremity. The major advantage is a hands-off approach to an already delicate segment of skin.