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    Jan
  • A Retrospective Study: MATERIALS AND METHODS

There were 42 patients obtained in this retrospective study with a variety of infections to wounds, including sternal, (Figure 1) spinal (Figure 2), and lower extremity (Figure 3). Data was collected for age, sex, predisposing factors, microorganisms, duration of wound VAC application, and wound heal­ing rates. Appropriate wound cultures were obtained from the sites after which antimicrobial therapy was started, if needed. The patient underwent operative and nonoperative debridement until healthy bleeding tissue and/or bone were revealed. Pulse lavage irrigation was utilized as well in some of the wounds. The VAC was then applied to the wound. The wound was evaluated every two to three days. The wound VAC was initiated by placing a foam dressing in the open wound. The polyurethane foam has a noncollapsible evacuation tube embedded, a vacuum pump, and a transparent adhesive drape (KCI International, San Antonio, TX) (Figures 4 and 5).

Figure la. Pre-VAC Sternal Wound

Figure 2a. Pre-VAC Spinal Wound

Figure 3a. Pre VAC Treatment Lower

The foam used is a medical grade reticulated polyurethane foam with а 400-600-цтЬ pore size. Side ports of the evacuation tube below communication of the lumen of the tube to spaces in the trabac-ulated foam and the open cell nature of the foam ensures equal distribution of the applied pressure to every surface of the wound that is in contact with the foam. The foam is then cut and contoured to fit the size of the defect. The foam is then connected through the evacuation tube with the VAC pump. The wound is then sealed with an adhesive drape. The suction generates enough vacuum in the wound, producing a high-contact zone in the wound foam interface, and a vacuum seal is then achieved. The polyurethane foam is then changed every two-to-three days with the drainage tube. This makes it possible for the wound to be inspected and avoids ingrowths of tissue into the foam. A container on the side of the VAC collects the wound exudate, which is changed weekly or upon filling capacity. The pump pressure is set between 125-150 mmHg depending on patient’s level of tolerance. Debridement with enzymatic compounds was occasionally used between dressing changes until good granulation tissue was present or until closure of the wound was achieved. Nonhealing wounds were defined as wounds that did not close two or more weeks after operative intervention or dehisced after closure. canada pharmacy mall

Figure 4. Wound VAC in Place with Sponge

Figure 4. Wound VAC in Place with Sponge
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Figure 5. Wound VAC Showing Active

Figure 5. Wound VAC Showing Active and Drainage Tube Drainage of Fluid

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